rss
Br J Ophthalmol 2006;90:1094-1097 doi:10.1136/bjo.2006.094060
  • World view

An outbreak of endophthalmitis after extracapsular cataract surgery probably caused by endotoxin contaminated distilled water used to dissolve acetylcholine

  1. T Boks1,
  2. J T van Dissel2,
  3. N Teterissa3,
  4. F Ros4,
  5. M H Mahmut5,
  6. E D Utama6,
  7. M Rol7,
  8. P van Asdonk8,
  9. S Airiani9,
  10. J C van Meurs10
  1. 1Logi Ster BV, Sliedrecht, Netherlands
  2. 2Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
  3. 3Nursing School, Sint Franciscus Gasthuis, Rotterdam, Netherlands
  4. 4Ophthalmology, Diakonessen Gasthuis, Utrecht, Netherlands
  5. 5Poliklinik Karya Kasih, Jalan Mongonsidi Ujung, Medan, North Sumatra, Indonesia
  6. 6Department of Bacteriology, Sint Elisabeth Hospital and Gleneagles Hospital, Medan, North Sumatra, Indonesia
  7. 7Ophthalmology Department, Rijnland Ziekenhuis, Leiderdorp, Netherlands
  8. 8Vision Clinics Amsterdam, Netherlands
  9. 9Edward S. Harkness Eye Institute, Columbia University, New York, USA
  10. 10The Rotterdam Eye Hospital, and Erasmus Medical Center, Rotterdam, Netherlands
  1. Correspondence to: Jan C van Meurs The Rotterdam Eye Hospital and Erasmus Medical Centre, Schiedamsevest 180, 3011 BH Rotterdam, Netherlands; janvanmeurs{at}cs.com
  • Accepted 1 May 2006
  • Published Online First 10 May 2006

Abstract

Aim: 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.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF
    4. All versions of this article:
      1. bjo.2006.094060v1
      2. 90/9/1094 most recent

    Responses

    1. Submit a response
    2. No responses published

    Register for free content

    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.