Corneal decompensation after cataract surgery. An outbreak investigation in Asia.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Courtright
P
P
University of British Columbia, Department of Ophthalmology, Faculty of Medicine, Vancouver, Canada.
Lewallen
S
S
Holland
S P
SP
Wendt
T M
TM
D001208:Asia / Q000453:epidemiology; D002387:Cataract Extraction / Q000295:instrumentation; D003315:Cornea / Q000187:drug effects* / Q000473:pathology; D015715:Corneal Edema / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D004196:Disease Outbreaks; D004202:Disinfectants / Q000009:adverse effects; D004203:Disinfection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005976:Glutaral / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D013525:Surgical Instruments; D014792:Visual Acuity
D004202:Disinfectants; D005976:Glutaral