Reusing Surgical Materials for Cataract Surgery: An Assessment of Potential Contamination.

PURPOSE: To evaluate microbiological cultures of cataract surgical devices and products that were reused for multiple cases. SETTING: Aravind Eye Hospital, Pondicherry, Tamil Nadu, India. DESIGN: Prospective cohort study. METHODS: Samples from multiple surgical instruments and products that were reused for consecutive cataract surgeries underwent bacterial and fungal cultures and were monitored alongside positive controls for 7 days. This included instruments that were processed using immediate use steam sterilization (IUSS) between cases (e.g., surgical cannulas, syringes, phacoemulsification and coaxial/bimanual irrigation and aspiration (IA) tips, phacoemulsification and IA sleeves) (Group 1), instruments that were used without sterilization between cases (e.g., phacoemulsification tubing/handpieces, coaxial IA handpieces) (Group 2) and the residual (unused) fluid from balanced salt solution bags after being used for multiple patients (Group 3). RESULTS: 3,333 discrete samples were collected from all 3 product groups that were reused across multiple patients. In all collected samples, no bacterial or fungal growth was observed. Of the 3,241 cataract surgeries that utilized reused and IUSS-sterilized instruments alongside instrument sets cultured on the same day and balanced salt solution bags shared across multiple patients, no eyes developed endophthalmitis over a 6-week follow-up period. CONCLUSION: Bacterial or fungal growth was not found in extensive microbiological cultures of IUSS-sterilized ophthalmic surgical instruments, and cataract surgical products that were reused in multiple patients. This microbiological data complements clinical endophthalmitis data from 2 million consecutive cases at the Aravind Eye Hospital, suggesting that their instrument and surgical supply processing practices may allow for safe and sustainable ophthalmic care.

Retrospective analysis of the role of anterior segment optical coherence tomography and outcomes of cataract surgery in posterior polar cataract.

Purpose: To evaluate the visual and surgical outcomes of cataract surgery in patients with posterior polar cataract (PPC) and to evaluate the benefits of preoperative anterior segment optical coherence tomography (AS-OCT). Methods: This was a retrospective, single-center study. Case records of patients diagnosed with PPC who underwent cataract surgery either by phacoemulsification or manual small-incision cataract surgery (MSICS) from January to December 2019 were analyzed. Data collected include demographic details, preoperative best corrected visual acuity (BCVA), AS-OCT, type of cataract surgery, intraoperative and postoperative complications, and visual outcome at 1-month follow-up. Results: One hundred patients were included in the study. Preoperative posterior capsular defect was noted on AS-OCT in 14 patients (14%). Seventy-eight underwent phacoemulsification and 22 underwent MSICS. Intraoperatively, posterior capsular rupture (PCR) was seen in 13 patients (13%) and cortex drop was noted in one among them (1%). Out of 13 PCRs, 12 were found to have posterior capsular dehiscence preoperatively in AS-OCT. The sensitivity of AS-OCT for detecting posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value and negative predictive value were 85.7% and 98.8%, respectively. There was no significant difference in the incidence of PCR between phacoemulsification and MSICS (P = 0.475). The mean BCVA at 1 month was found to be better with phacoemulsification than MSICS (P = 0.004). Conclusion: Preoperative AS-OCT has excellent specificity and negative predictive value in identifying posterior capsular dehiscence. It thus helps to plan the surgery and counsel patients appropriately. Both phacoemulsification and MSICS provide good visual outcome with similar complication rates.

Piggyback miLOOP-assisted phacoemulsification combined with intraocular lens scaffold in hypermature cataracts.

Hypermature cataracts with liquified cortex pose a higher risk for capsular complications due to a distended capsular bag, floppy posterior capsule, and absence of any cushioning epinucleus. Disassembly of a brunescent nucleus is more difficult because of the thickened, leathery posterior plate. Relying on mechanical forces, miLOOP nucleotomy reduces ultrasound time and is assured of bisecting the posterior nuclear plate. However, using this instrument with brunescent nuclei might impart significant stress on the zonular fibers and posterior capsule, particularly if there is no epinuclear shell. Evacuating the liquefied cortex and prolapsing one nuclear pole through capsulorhexis with ophthalmic viscosurgical devices create enough space to implant an intraocular lens (IOL) into the capsular bag beneath the undivided nucleus. This IOL scaffold shields the floppy posterior capsule and stabilizes the nucleus and zonular fibers during miLOOP nucleotomy. Combining and piggybacking these 2 techniques successfully avoided capsular and corneal complications in a series of 32 cases.