‘Comprehensive’ sterilization system can reduce endophthalmitis cases to zero

SAN DIEGO, Calif. — The prevention of endophthalmitis will likely be accomplished with a “comprehensive prophylaxis program” rather than the implementation of any one single step, according to one surgeon.

Randall E. Cole, MD, outlined a system for preventing this devastating complication here at the American Society of Cataract and Refractive Surgery meeting. His experience was derived from a clinic in northwest Arkansas, he said, where seven surgeons have performed 15,000 consecutive intraocular procedures without a single incidence of endophthalmitis.

An “obsessive” sterilization protocol has been in place since the surgery center opened in 1996, and in that time the incidence of endophthalmitis (0%) has been far below the expected occurrence of 0.12% of procedures, Dr. Cole said.

This statistic takes into account all intraocular procedures, including phacoemulsifcation (the vast majority of cases), trabeculectomy and others.

The center’s sterilization protocol includes steps such as bimonthly equipment maintenance, careful patient screening (and surgical postponement) for systemic infection or high blood sugar, adhesive drapes for lid margins, full body and head drapes, and changing the irrigation solution after each patient.

Preoperatively, patients are advised to wash their faces several times a day with antibacterial soap for 3 days. Postoperatively, they are given Vigamox (moxifloxacin, Alcon) or Zymar (gatifloxacin, Allergan) four times daily during week 1 and twice daily during week 2.

Dr. Cole also noted that even 3-mm clear corneal incisions, which accounted for 66% of cases, do not appear raise the incidence of endophthalmitis when a comprehensive prophylaxis system is followed.