Postoperative inflammation following cataract extraction caused by bacterial contamination of the cleaning bath detergent

Abstract

Five of 16 patients who had uncomplicated cataract extraction with intraocular lens (IOL) implantation within a 2.5 day period experienced increased anterior segment inflammation on their first postoperative day. Four of these five patients had phacoemulsification and one a planned extracapsular cataract extraction. All had posterior chamber IOL implantation in the capsular bag. In all patients, this anterior segment inflammation cleared with topical steroids over two to three weeks with no evident residual ocular effects. A careful search for the possible cause of the inflammation showed that the ultrasonic cleaning bath and Weck liquid detergent used to clean the instruments contained Klebsiella pneumoniae bacteria. Further investigation demonstrated the presence of a heat-stable endotoxin produced by the bacteria. We postulate that endotoxin remaining on the instruments after cleaning and sterilization caused this postoperative anterior segment inflammation. To the best of our knowledge, these are the first reported cases caused by contaminated liquid detergent.

Fulminant Culture Negative Endophthalmitis as a New Entity, Toxic Posterior Segment Syndrome?

“…However, in the OR, the wound was found to be sealed and thus no intracameral injections were performed. TASS may occur due to abnormalities in the pH or ionic composition of irrigating saline solutions [22]. Nevertheless, BSS was only used topically.…”

Residual debris as a potential cause of postphaco- emulsification endophthalmitis

“…9,11 Other outbreaks have been presumed to be because of defective sterilisation and/or poor operative room hygiene, 12,13 and in these cases a variety of causative organisms can be found in one outbreak. In others, the same organism is implicated in all or most cases and intraoperative contamination can be identified, for example, internal contamination of the phacoemulsification machine 14,15 or the vitrectomy apparatus; 16,17 contamination of the ultrasonic cleaning bath and detergent, 18 viscoelastic, 19 Figure 7 Diatoms.…”

“…10 Although cases of endophthalmitis are usually isolated, clustered outbreaks have been described and exogenous sources have sometimes been identified. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] In a 14-week period, at the end of 1999, there were eight cases of postphacoemulsification endophthalmitis in the Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow. The Tennent Institute is the tertiary referral unit for Glasgow and the West of Scotland.…”

Toxic Anterior Segment Syndrome (TASS) and Prophylaxis Against Postoperative Endophthalmitis

“…Gram-negative bacteria can be found in water baths, ultrasound baths and autoclave reservoirs. This bacteria are destroyed during heat sterilization but their heat-stable bacterial wall endotoxines remain intact and can deposit on instruments (Kreisler et al, 1992) (Holland & Morck, 2007) (Andonegui et al, 2009). Another author (Hellinger et al, 2006) found sulphate, copper, zinc or silica impurities in the autoclave steam moisture.…”