CORNEAL DECOMPENSATION AFTER CATARACT-SURGERY - AN OUTBREAK INVESTIGATION IN ASIA

Purpose: During 5 days in January 1994, two visiting expatriate ophtha lmologists performed extracapsular cataract surgery on 11 1 patients a t a nonprofit hospital in Asia. The authors investigated the developme nt of postoperative corneal edema. Methods: An epidemiologic and clini cal investigation was undertaken by a review of clinical charts, inter view of personnel involved, an examination and interview of patients w ho underwent surgery, and a laboratory simulation of the disinfection procedure used. Results: Follow-up was available on 58% of the patient s. The attack rate was at least 37% and likely to be approximately 64% . The attack rate was highest the first 2 days of surgery. Multivariat e analysis showed that the day of surgery was the only characteristic significantly associated with the presence of corneal edema. A simulat ion of the disinfection technique used (soaked in 2% glutaraldehyde an d rinsing) showed that significant levels of glutaraldehyde remain in instruments with small lumens after the rinse. Conclusion: The epidemi ologic data and simulation information are compatible; the lack of ade quate rinsing of small lumen instruments soaked in glutaraldehyde is t he most probable cause of this incident. Recommendations for surgeons on surgical expeditions are proposed.