title: An outbreak of endophthalmitis after extracapsular cataract surgery probably caused by endotoxin contaminated distilled water used to dissolve acetylcholine.
abstract: OBJECTIVE
  To study possible causes of an outbreak of severe endophthalmitis after planned extracapsular cataract surgery in Medan, Indonesia.
  
  
  METHODS
  In a 3 week period in November 2001, 17 of 43 patients developed signs of endophthalmitis after planned extracapsular cataract surgery. A search for possible causes was undertaken 4 months later.
  
  
  RESULTS
  In autoclaved stored distilled water used to dissolve acetylcholine (used in 16 of 17 patients with endophthalmitis) a high amount of endotoxin was detected in a human blood essay, as well as a small number of non-typeable Pseudomonas spp.
  
  
  CONCLUSIONS
  These findings suggest that distilled water used as solvent for acetylcholine was responsible for this outbreak of endophthalmitis. As a consequence, we now rely on solvents that are regularly checked for impurities such as an intravenous infusion fluid, rather than on vials with distilled water that is presumed to be sterile and kept for some time.
authors: Logi Ster BV, Sliedrecht, Netherlands.
authors: T
authors: T
authors: Boks
authors: J T
authors: JT
authors: van Dissel
authors: N
authors: N
authors: Teterissa
authors: F
authors: F
authors: Ros
authors: M H
authors: MH
authors: Mahmut
authors: E D
authors: ED
authors: Utama
authors: M
authors: M
authors: Rol
authors: P
authors: P
authors: van Asdonk
authors: S
authors: S
authors: Airiani
authors: J C
authors: JC
authors: van Meurs