Recommendations for an expert team investigating a case of cluster endophthalmitis

Abstract

Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients. Due to its multifactorial etiology, surveillance of such an event is extremely important to identify the causative factor and to prevent recurrences in future. For surveillance, a team of ophthalmologists and microbiologists is often appointed by the local health department, and it is imperative that this team investigates thoroughly, reports appropriately safeguarding the interests of all, and also suggests remedial measures for future. Much literature is available on postoperative endophthalmitis and sterilization and disinfection protocols, but to the best of our knowledge, there is none to guide the surveillance team regarding the conduct of the entire process of investigation in the case of such unfortunate incidents. Through this article, we have made an attempt to formulate recommendations for expert teams investigating cases of postoperative cluster endophthalmitis.

Cataract surgery clinical features, treatment and operational difficulties in management of cluster endophthalmitis

“…Besides managing the cases on an emergency basis, ample time should be devoted to preoperative counselling, there has to be proper planning with special attention to logistics and hygiene of patient and close postoperative follow up to identify the complication at the earliest. 35 The National Program for Control of Blindness (NPCB) norms for service delivery in eye camps emphasizes that camps should be held under controlled conditions with due permissions and safety measures, always in a permanent operation theatre setup. It is also mandated that all the drugs and solutions for intraocular use should be procured in advance from GMP-certified manufacturers and the batch is evaluated for contamination by microbiological tests and fluids for intraocular use should be autoclaved before use in camp setting.…”

Commentary: The changing scenario of cluster endophthalmitis

“…In the current issue of Indian Journal of Ophthalmology, the authors have highlighted the most important steps to be carried out while evaluating cluster endophthalmitis. [ 2 ] The immediate measures ideally are to spread awareness, prevent the further outbreak, and to ensure safety of the affected patients. Then a sequence of investigations should be followed to identify the cause of the outbreak.…”

“…The authors have elaborately discussed the steps to be carried out in an emergency but the discussion is a bit laborious. [ 2 ] Hence, in a nutshell, the panel or team should conduct a proper patient workup, evaluate certain entities such as the process of operation theatre sterilization, preoperative patient care, intraoperative techniques and monitor the proper use of irrigating solutions, instruments, phaco tubings, etc.…”