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

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