Corneal decompensation after cataract surgery. An outbreak investigation in Asia

During 5 days in January 1994, two visiting expatriate ophthalmologists performed extracapsular cataract surgery on 111 patients at a nonprofit hospital in Asia. The authors investigated the development of postoperative corneal edema.

An epidemiologic and clinical investigation was undertaken by a review of clinical charts, interview of personnel involved, an examination and interview of patients who underwent surgery, and a laboratory simulation of the disinfection procedure used.

Follow-up was available on 58% of the patients. The attack rate was at least 37% and likely to be approximately 64%. The attack rate was highest the first 2 days of surgery. Multivariate analysis showed that the day of surgery was the only characteristic significantly associated with the presence of corneal edema. A simulation of the disinfection technique used (soaked in 2% glutaraldehyde and rinsing) showed that significant levels of glutaraldehyde remain in instruments with small lumens after the rinse.

The epidemiologic data and simulation information are compatible; the lack of adequate rinsing of small lumen instruments soaked in glutaraldehyde is the most probable cause of this incident. Recommendations for surgeons on surgical expeditions are proposed.