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| LETTER TO EDITOR |
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| Year : 2004 | Volume
: 52
| Issue : 3 | Page : 260-1 |
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Phacoendophthalmitis.
V Vedantham
Correspondence Address:
V Vedantham
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 15510477 
Keywords: Disinfection, Endophthalmitis, etiology, Equipment Contamination, prevention & control, Humans, Phacoemulsification, adverse effects, instrumentation, Sterilization
How to cite this article:
Vedantham V. Phacoendophthalmitis. Indian J Ophthalmol 2004;52:260 |
Dear Editor,
I read with great interest the letter by Rao et al, on debris in phacoemulsification handsets.[1] The authors deserve to be congratulated for their study that is in all probability, the first in the Indian scenario. There are some points that I would like to supplement in this regard.
1. Interestingly, studies in branches of medicine other than ophthalmology on effective sterilisation of solid surgical instruments too stress the importance of adequate cleaning/processing of the instruments (particularly the ones with a narrow lumina) prior to disinfection/sterilisation.[2],[3] The potential for contamination of a single-use biopsy forceps at various stages of colonoscope reprocessing was prospectively evaluated by Kinney et al.[2] The authors concluded that proper endoscope reprocessing might be the most important factor in preventing biopsy forceps-related interpatient infection.
The efficacy of disinfection and sterilisation of reusable angioscopes to prevent transmission of Duck Hepatitis B virus (DHBV) was evaluated by Chaufour et al.[3] They found that there was no disease transmission after reuse of disposable angioscopes that were adequately cleaned before disinfection or sterilisation. However, if the angioscopes were inadequately cleaned, DHBV was found to survive despite glutaraldehyde disinfection or ethylene oxide sterilisation. The authors postulated that the presence of a narrow lumen or residual protein shielding within the lumen might compromise effective inactivation of hepadnaviruses on angioscopes.
2. It is true that automated flushing with pre-set pressure settings for use with phaco tubings, U/S handpieces, I/A handpieces, vitreous cutters and cannulas has the advantage of allowing for the rapid turnaround of surgical instruments. The authors too have suggested that automated flushing is an effective mechanism to decrease the build-up of debris in the handsets.[1] However, interestingly a recent study by Leslie et al[4] showed that although contamination decreased after automated flushing, it was not completely eliminated. Hence we should not be complacent even if such an automated system is used. Prompt and efficient manual cleaning and flushing by trained surgical assistants and regular inspection of all the multiple-use intraocular instruments, especially those with a narrow lumen is perhaps the most important step in preventing debris-related endophthalmitis not only following phacoemulsification but also after any intraocular surgery.
| References | |  |
| 1. | Rao SK, Baskaran M, Ramana Kumar PJ, Vijaya L, Madhavan HN. Debris in phacoemulsification handsets. A potential cause of endophthalmitis after cataract surgery. Indian J Ophthalmol 2004;52:80-81.  |
| 2. | Kinney TP, Kozarek RA, Raltz S, Attia F. Contamination of single-use biopsy forceps: A prospective in vitro analysis. Gastrointest Endosc 2002;56:209-12. [ PUBMED] [ FULLTEXT] |
| 3. | Chaufour X, Deva AK, Vickery K, Zou J, Kumaradeva P, White GH, et al. Evaluation of disinfection and sterilization of reusable angioscopes with the duck hepatitis B model. J Vasc Surg 1999;30:277-82. [ PUBMED] [ FULLTEXT] |
| 4. | Leslie T, Aitken DA, Barrie T, Kirkness CM. Residual debris as a potential cause of post phacoemulsification endophthalmitis. Eye 2003;17:506-12. [ PUBMED] [ FULLTEXT] |
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