Intraocular Irrigating Solutions Research Articles

Einfluss der Katarakt- und Glaskörperchirurgie auf die Hornhautdicke und die Corneale Hysterese

Intraocular irrigating solutions remain for several hours beyond the actual time of surgery in the eye. The irrigating solution ought to resemble biochemically aqueous humor and vitreous and offer protection for sensitive structures of the eye, such as the corneal endothelium. Impairment of the corneal endothelium may lead to corneal oedema and biomechanical alterations of the cornea. 54 eyes after pars-plana vitrectomy (PPV) in elective macular surgery were evaluated by measuring corneal thickness (CCT) using ultrasound pachymetry (20 MHz) and corneal hysteresis (CH) using the ocular response analyser (Reichert Ophthalmic Instruments, Buffalo, NY, USA). Measurements were performed not earlier than 2 weeks prior to surgery and 1 to 3 days after surgery. Results were compared to a control group (n = 39) and to 101 eyes after clear cornea cataract extraction (KAT). The two groups (PPV and KAT) did not differ with respect to age (p = 0.555). Corneal thickness has increased significantly in both groups (p <or= 0.001, mean difference: PPV group 34.95 +/- 23.57 microm and KAT group 23.76 +/- 26.0 microm, respectively) whereas corneal hysteresis decreased significantly postoperatively (p <or= 0.001; 1.93 +/- 3.15 mmHg after PPV and 1.15 +/- 2.65 mmHg after cataract surgery, respectively). Postoperative changes were significantly higher in the PPV group (CCT p <or= 0.01 and CH p = 0.011, respectively). Surgically induced changes of the cornea may not only be characterized by anatomic parameters such as corneal thickness but also by biomechanical parameters such as corneal hysteresis.

Effects of ascorbic acid on UV light-mediated photoreceptor damage in isolated rat retina

Concerns have been raised about whether operating microscopes and endoillumination used during ophthalmic surgeries contribute to retinal damage. Despite the recognition that ascorbic acid (vitamin C) helps to protect the eye from light and the abundance of vitamin C in the retina, artificial aqueous humors used during surgery only contain the antioxidant glutathione. To test whether inclusion of antioxidants other than glutathione in surgical solutions might help to preserve retinal integrity, we studied the effects of vitamin C on acute toxicity in isolated rat retinas. Male Sprague–Dawley rats (PND 30 ± 2) were sacrificed for retinal isolation. In the presence or absence of vitamin C (1 or 3 mM), retinas were exposed to 302 nm ultraviolet B (UVB) light for 1 h and were incubated for a total of 5 h at 30 °C. Retinal damage was assessed by morphological examination and biochemical assay measuring the amount of lactate dehydrogenase (LDH) released from injured cells. In control retinas, LDH release was significantly increased after UVB exposure. The presence of 1 mM vitamin C in the incubation media significantly reduced LDH release during the post-incubation period following UV exposure. No difference was found between 1 and 3 mM vitamin C. Microscopic examination revealed that disorganization in the outer nuclear layer after UVB exposure was markedly attenuated by administration of 1 mM vitamin C. Vitamin C (1 mM), a concentration found in the anterior chamber in humans, but not glutathione, prevented phototoxic injury following UV exposure. Although vitamin C itself cannot be used in intraocular irrigating solutions because of adverse interactions with iron released during bleeding, inclusion of antioxidants equivalent to vitamin C should be considered to help protect the retina from intraoperative light toxicity.

EFFECT OF OXYGENATED INTRAOCULAR IRRIGATION SOLUTIONS ON THE ELECTRORETINOGRAM AFTER VITRECTOMY

To investigate the effect of oxygenated intraocular irrigating solutions on electroretinograms (ERGs) for postvitrectomy rabbits. Eight groups of five rabbits each underwent pars plana vitrectomy on the right eye; the left eye of each rabbit served as control. The intraocular irrigating solutions were balanced salt solution (BSS), BSS-plus, BSS + oxygen (BSS + O2), BSS-plus + O2, and combinations of each with the addition of endoillumination (L). All animals were evaluated by single-flash scotopic electroretinography on the operated and nonoperated eyes before surgery and at 1 hour, 1 day, 1 week, and 1 month after surgery by an unmasked observer. The main outcome measures were dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios. The results for the different groups were compared by analysis of variance. Mean dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios +/- SD for BSS-plus and BSS-plus + O2 before surgery and 1 hour, 1 day, 1 week, and 1 month after surgery were 1.01 +/- 0.09, 0.50 +/- 0.11, 0.95 +/- 0.11, 0.97 +/- 0.11, and 0.99 +/- 0.08 and 0.98 +/- 0.08, 0.59 +/- 0.10, 0.92 +/- 0.06, 0.97 +/- 0.08, and 0.97 +/- 0.10, respectively. At both 1 hour and 1 day after surgery, rabbits treated with BSS-plus + O2 had an earlier b-wave return to baseline findings, but the differences were not statistically significant (P > 0.05). Mean dark-adapted b-wave amplitudes of operated eye/nonoperated eye ratios +/- SD for BSS and BSS + O2 before surgery and 1 hour, 1 day, 1 week, and 1 month after surgery were 1.02 +/- 0.10, 0.47 +/- 0.09, 0.77 +/- 0.07, 0.89 +/- 0.07, and 0.89 +/- 0.07 and 1.02 +/- 0.06, 0.62 +/- 0.16, 0.94 +/- 0.09, 0.97 +/- 0.08, and 0.96 +/- 0.06, respectively. One hour and 1 day after surgery, ERG readings for rabbits treated with BSS + O2 exhibited a statistically significantly earlier return of ERG voltage to baseline values compared with both BSS and BSS + L (P = 0.05 and P = 0.02, respectively). One day after surgery, rabbits treated with BSS alone had the lowest ERG ratios. One week and 1 month after surgery, for all solutions tested other than BSS, ERG values were within normal limits. The use of oxygenated solutions appears to affect ERG readings after pars plana vitrectomy. Further studies to evaluate the role of oxygenated solutions in different vitreoretinal surgical procedures are warranted.

A NOVEL METHOD TO OXYGENATE INTRAOCULAR IRRIGATION FLUIDS WITH AN IN-LINE OXYGENATOR

We describe a novel method to oxygenate intraocular irrigation solutions involving an in-line oxygenator. Either lactated Ringer (LR) solution or balanced salt solution (BSS) was oxygenated with the FE390 Stainless In-line Oxygenation Assembly (Beer, Beer, and More Beer, Concord, CA). After running a 100-mL of solution through the in-line oxygenator, oxygen saturation was measured with a dissolved oxygen meter. A control experiment involving the oxygenator without oxygen perfusion was performed. Paired t-tests were used to compare oxygen saturation changes before and after oxygenation. In comparison with the original BSS, there was an increase in oxygen saturation of 162 +/- 47% (n = 40; P < 0.05). Without oxygenation perfusion, there was only a 24 +/- 14% (n = 40) increase in oxygen levels in BSS, which was significantly lower than that in treated BSS (P < 0.05). In comparison with the original LR solution, there was an increase in oxygen saturation of 208 +/- 21% (n = 40; P < 0.05). Without oxygenation perfusion, there was only a 21 +/- 9% (n = 40) gain in oxygen saturation in the control LR solution, which was statistically lower as well (P < 0.05). The in-line oxygenator is an efficient tool for oxygenating BSS and LR solution. It represents a potential efficient and convenient method to oxygenate irrigating solutions for vitreoretinal surgeries.

Changes in vitreous amino acid concentrations in a rabbit model of cataract surgery

We previously reported marked elevation of glutamate, gamma-aminobutyric acid (GABA) and alanine in the vitreous after combined cataract surgery and vitrectomy for macular disorder. Photo-stimulation by the operating microscope and increased intraocular pressure (IOP) are possible causes of postoperative increases in amino acids. An animal model was used to verify this hypothesis. Forty-five coloured rabbits were studied; stress was applied to simulate cataract surgery. Simultaneous photic and pressure stress, photic stress alone, or pressure stress alone were exerted for 20 mins. The vitreous was extracted at the end of the stress period, or 10 mins or 30 mins later. Levels of six amino acids (asparate, glutamate, glycine, taurine, alanine and GABA) in the vitreous were analysed quantitatively. Significant increases in vitreous glutamate concentrations in treated eyes were observed following simultaneous photic and pressure stress, as well as after pressure stress alone, whereas no difference was found after photic stress alone. The mean glutamate concentrations in treated eyes and fellow eyes, respectively, were 5.59 +/- 2.03 microM and 4.36 +/- 2.09 microM (p < or = 0.05) 10 mins after simultaneous photic and pressure stress, and 4.32 +/- 0.97 microM and 2.29 +/- 0.51 microM (p < 0.05) 10 mins after pressure stress alone. Taurine concentration was elevated by pressure stress alone at 0 min and at 10 mins post-stress. Alanine concentration was reduced by photic stress alone at 10 mins post-stress. In all protocols, no significant differences between treated and fellow eyes were observed at 30 mins after stress. Time-dependent changes were observed not only in the treated eyes, but also in untreated fellow eyes. Elevations of vitreous glutamate in cataract surgery may be caused by pressure stress due to irrigation. Photic stress caused by the operating microscope has little influence. Sympathetic response may be involved in amino acid changes due to stress in cataract surgery.

Acoustic cavitation in phacoemulsification and the role of antioxidants

Cataract surgery by phacoemulsification generates acoustic cavitation, resulting in formation of reactive oxygen species. The aim of this study was to establish the mechanism of damage by phacoemulsification in an in vitro setting simulating cataract surgery and to assess the protective effects of water-soluble antioxidants. Electron paramagnetic resonance spectroscopy was used to analyze generation of radicals in an intraocular irrigating solution by phacoemulsification instrumentation, operating at an ultrasonic frequency range of 40–60 kHz. Hydroxyl radicals were generated by phacoemulsification under conditions simulating cataract surgery. The effects of water-soluble antioxidants in the irrigating solution on the amounts of radicals were evaluated by electron paramagnetic resonance spectroscopy. The water-soluble antioxidant glutathione, applied in either oxidized or reduced form, decreased hydroxyl radicals concentration measured in the sonicated medium. The effective concentrations of oxidized and reduced glutathione in irrigating solution that significantly eliminate the hydroxyl radical signal were determined in the range of 10 −3–10 −2 M. Antioxidants should be applied clinically to reduce damage to the corneal endothelium induced by phacoemulsification, thereby improving biosafety. (E-mail: topazmd@netvision.net.il)

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment

To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.

Heparin in the intraocular irrigating solution in pediatric cataract surgery

Purpose: To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery. Setting: Department of Ophthalmology, Inönü University, Turgut Özal Medical Center, Malatya, Turkey. Methods: Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared. Results: In Group 1a (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group 1a having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1a that had secondary IOL implantation. Conclusions: Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood–aqueous barrier such as after previous ocular surgery.

Prednisolone and flurbiprofen drops to maintain mydriasis during phacoemulsification cataract surgery

Purpose: To compare the effects on the pupil of pretreatment with prednisolone 1% eyedrops, flurbiprofen 0.03% eyedrops, and sodium chloride 0.9% eyedrops in patients having phacoemulsification cataract surgery. Setting: Christopher Home Eye Unit, Royal Albert Edward Infirmary, Wigan, United Kingdom. Methods: One hundred thirty-six white patients having phacoemulsification with no history of eye disease, antiinflammatory medication, or diabetes were enrolled in this prospective randomized double-blind study. Patients were allocated to receive flurbiprofen 0.03%, prednisolone 1%, or sodium chloride 0.9% (placebo) eyedrops at 30-minute intervals beginning 2 hours before surgery. All patients received cyclopentolate 1% and phenylephrine 2.5% drops preoperatively and epinephrine 1:10 6 intraoperatively in the intraocular irrigating solution. The pupil diameter was measured from a television screen at the preset magnification of the operating microscope immediately before the incision, at the end of nucleus emulsification, at the end of irrigation/aspiration (I/A), and at the end of surgery. One hundred twelve patients with a baseline pupil diameter of at least 6.0 mm who had uneventful phacoemulsification were analyzed. Results: The baseline pupil diameters were statistically similar. An analysis of variance did not reveal an overall significant mydriasis-maintaining effect of prednisolone or flurbiprofen compared to the placebo at any stage of surgery ( P = .16 to .37). The 95% confidence interval showed flurbiprofen to be superior to prednisolone at the end of surgery. According to the paired t test, the reduction from the baseline at the end of I/A in the prednisolone group ( P = .051) and at the end of surgery in the flurbiprofen group ( P = .22) was not significant. Conclusion: In the presence of epinephrine in the intraocular irrigating solution, both prednisolone 1% and flurbiprofen 0.03% failed to maintain mydriasis at the crucial steps of nuclear emulsification and cortical I/A.

Effect of cooled intraocular irrigatingsolution on the blood-aqueous barrier after cataract surgery

Purpose: To evaluate the effect of cooled intraocular irrigating solution during phacoemulsification on postoperative blood-aqueous. barrier (BAB) disturbance. Setting: Department of Ophthalmology, University of Vienna, Austria, Methods: In a prospective, randomized clinical study, 40 eyes with senile cataract had phacoemulsification with irrigating solutions cooled to approximately 10°C (n = 20) or at room temperature (n = 20). Surgical procedure and postoperative therapy were otherwise identical in both groups. Postoperative BAB disturbance was assessed with the laser flare-cell meter on days 1, 3, 7, 14, and 28. Results: Anterior chamber flare was significantly lower in the group with cooled irrigating solution on postoperative day 1. There was no significant between-group difference in flare on any other postoperative day. Conclusion: Cooled intraocular irrigating solution reduced immediate postoperative inflammation compared with irrigating solution at room temperature. However, this effect was of short duration.

Intracameral anesthesia: in vitro iris and corneal uptake and washout of 1% lidocaine hydrochloride.

To characterize the uptake, washout, and metabolism of lidocaine hydrochloride in the iris/ciliary body and cornea. Iris/ciliary body uptake of lidocaine hydrochloride was measured by incubating human and rabbit irides in radiolabeled carbon 14-1% lidocaine hydrochloride for 2 to 60 minutes. Washout was determined by incubating the iris in 14C-1% lidocaine hydrochloride for 5 minutes and transferring the iris to a series of wells. The wells contained a common intraocular irrigating solution of essential ions, glucose, and glutathione buffered with bicarbonate (an enriched balanced salt solution [BSS PLUS]), which is similar to aqueous humor. Corneal uptake was measured by exposing the endothelial surface to 14C-1% lidocaine hydrochloride for 5 or 15 minutes. Corneal washout was performed after 5-minute exposure to 14C-1% lidocaine hydrochloride using a 2-chambered diffusion apparatus. Samples of the iris, cornea, and BSS PLUS washout solution were analyzed by high-performance liquid chromatography and liquid scintillation spectrometry. In vitro iris/ciliary body uptake of 14C-1% lidocaine hydrochloride follows a logarithmic curve, with 50% to 60% of maximum lidocaine hydrochloride uptake present at 5 minutes. There was no difference in uptake between human, albino rabbit, and pigmented rabbit irides. Washout of lidocaine from the iris occurs with a halflife of 8 to 9 minutes. Corneal uptake of lidocaine was greater after incubation for 15 vs. 5 minutes. The washout of lidocaine from the cornea had a half-life of 5 minutes. Results of high-performance liquid chromatography confirmed that there were no metabolites or breakdown products in the iris, cornea, or washout solution. Lidocaine is taken up quickly by the iris/ ciliary body and cornea and rapidly removed from these tissues after BSS PLUS washout. Irrigation during phacoemulsification seems to limit lidocaine exposure to the ocular tissues, resulting in a short duration of anesthesia. Lidocaine is not metabolized or broken down by the iris or cornea during this short period.

Effect of Intraocular Irrigating Solution on Flicker Electroretinogram During Cataract Surgery in Human Eye

The effects of two commercially available intraocular irrigating solutions, Opeguard MA and BSS Plus, were studied during extracapsular cataract surgery in 45 eyes of 35 patients. After irrigation and aspiration of the residual cortex with Opeguard MA or BSS-Plus, the ERG amplitude increased, respectively, to 111.2 ± 5.8% and 109.5 ± 5.3% of the preirrigation amplitudes. The increases reached significance (116.9 ± 7.0% and 115.7 ± 6.5%; both P < .05) at the end of surgery compared with pre-irrigation ERG amplitudes. After irrigation with Opeguard MA or BSS-Plus, the ERG peak times were significantly prolonged to 103.9 ± 0.8% and 104.2 ± 1.2%, respectively, of the preirrigation peak times (both P < .01). The ERG peak times significantly shortened to 101.5 ± 0.9% and 101.3 ± 1.22%, respectively, at the end of surgery ( P < .001 and P < .05) compared with just after irrigation. Although we have previously shown that Opeguard MA maintained amplitude and implicit time of 30 Hz flicker ERG during vitrectomy better than BSS-Plus, there were no statistically significant differences between the changes in amplitude and peak time with Opeguard MA and BSS-Plus during cataract surgery. We speculate that a drop in the retinal temperature during irrigation and aspiration in the anterior chamber and an increase in the photopic ERG amplitude during light adaptation with the operating microscope caused these ERG changes.

Effect of supplemented and nonsupplementedvancomycin in the intraocular irrigating solutions onthe incidence of endophthalmitis afterphcoemulsification : A pilot study

Effect of supplemented and nonsupplementedvancomycin in the intraocular irrigating solutions onthe incidence of endophthalmitis afterphcoemulsification : A pilot study

Adhesiveness of AcrySof to a collagen film

Purpose: To measure the adhesiveness of the AcrySof® intraocular lens (IOL) to a collagen film to ascertain its capacity to adhere to the lens capsule.Setting: Haibara General Hospital, Haibara, and Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.Methods: Each of five AcrySof IOLs was attached to a collagen film, slightly pressed in intraocular irrigating solution, and then pulled up and off the film with a DuNouy's surface balance. The force recorded by the surface balance at the moment it detached from the film was defined as the lens' adhesiveness. A control experiment was performed using five conventional poly(methyl methacrylate) (PMMA) IOLs.Results: Mean adhesiveness was 2.76 gram-weight (gw) ± 0.55 (SD) for AcrySof and 0.81 ± 0.20 gw for PMMA. The difference was statistically significant (P < .0001, t-test).Conclusion: AcrySof may have a strong tendency to adhere to the lens capsule, contributing to posterior and anterior capsule clarity and preventing lens decentration in vivo.

Vancomycin prophylaxis and intraocular contamination during cataract surgery

Purpose: To investigate the effect of vancomycin added to the intraocular irrigation solution to prevent anterior chamber contamination during phacoemulsification.Setting: Centre Hospitalier, Villeneuve-Saint-Georges, France.Methods: A group of 372 patients having cataract extraction by phacoemulsification was divided into two consecutive, nonrandomized groups. The first group (n = 190) was a control; there was no antibiotic in the irrigation solution. The second group (n = 182) received vancomycin in the irrigation solution. Intraocular fluid was aspirated at the end of surgery and injected into a blood culture bottle to evaluate bacterial contamination of the anterior chamber.Results: There was no between-group difference in bacterial intraocular contamination. Eight samples in the first group were contaminated and nine in the second group. All contaminants were gram-positive vancomycin-sensitive organisms.Conclusions: Adding vancomycin to the intraocular irrigation solution during cataract surgery had no effect on the occurrence of intraocular contamination as evaluated by anterior chamber taps.

Intraocular irrigating solutions and barrier function of retinal pigment epithelium

AIMTo study the effect of intraocular irrigating solutions on the barrier property of the retinal pigment epithelium (RPE).METHODSThe isolated rabbit RPE–choroid mounted on Ussing-type chambers under short circuit conditions was...

Effect of intraocular irrigating solutions on the viability of cultured retinal vascular endothelial cells

Purpose. To compare the abilities of balanced salt solution, BSS Plus and Hartmann's lactated Ringer's (HLR) solution to maintain the viability of retinal vascular endothelial cells (RVEC) in vitro. Methods. Cultured retinal vascular endothelial cells were suspended in each irrigating solution for four hours. Viability was determined by trypan blue exclusion at 30 minute intervals. Regression analysis was used to determine the rate of viability loss. Additional studies were performed to determine the effectiveness of lactate in maintaining cell viability. Results. Retinal vascular endothelial cells lost viability at a greater rate (p < 0.001) in BSS (8.7%/hr) compared with BSS Plus (3.3%/hr). Cells in Hartmann's lactated Ringer's lost viability at a significantly lower rate (4.4%/hr) than retinal vascular endothelial cells in lactate-free Hartmann's lactated Ringer's solution (8.4%/hr). Lactate was as effective as glucose in preserving RVEC viability. By comparison, the viability of corneal endothelial cells was not effectively maintained by lactate. For these cells, BSS Plus was clearly superior to Hartmann's lactated Ringer's solution in maintaining viability. Conclusions. BSS Plus and Hartmann's lactated Ringer's solution are both superior to balanced salt solution in maintaining retinal vascular endothelial cell viability. For retinal vascular endothelial cells, Hartmann's lactated Ringer's solution preserves cell viability as well as BSS Plus, since the retinal vascular endothelial cells, unlike corneal endothelial cells, can apparently utilize lactate as an energy source.

A comparative study of intraocular irrigating solutions: effects on electroretinography readings during closed vitrectomy in humans.

The effects of intraocular irrigating solutions on electroretinography have been extensively studied in animal models, but effects on human electroretinography have not been reported. This study examined the effects of two commercially available irrigating solutions, S-MA2 (Opeguard MA) and DE-057 (BBS-Plus) on 30-Hz flicker electroretinography during closed vitrectomy in humans. Eight eyes of 8 patients were examined. All patients underwent a simple vitrectomy without treatment of proliferative membrane. For 30-Hz flicker electroretinography recording, a contact lens with a built-in light-emitting diode was sterilized and used as both a stimulus source and a recording electrode. Replacing S-MA2 with DE-057 decreased the electroretinography amplitude from 55.8 +/- 15.2 to 45.5 +/- 13.2 microV (mean +/- SEM). Changing the irrigation solution from DE-057 back to S-MA2 increased the amplitude from 45.5 +/- 13.2 to 59.9 +/- 17.3 microV. However, these changes were not statistically significant. Replacing S-MA2 with DE-057 significantly increased the peak time from 50.1 +/- 1.5 to 57.6 +/- 1.3 msec (p < 0.001). This change was reversible; after changing from DE-057 back to S-MA2, the peak time of flicker electroretinography significantly decreased from 57.6 +/- 1.3 to 49.0 +/- 2.1 msec (p < 0.01). Thus intraoperative 30-Hz electroretinography showed delayed peak time during irrigation with DE-057, as compared with S-MA2. The lower potassium concentration and higher glucose concentration of S-MA2, as compared with DE-057, may be the cause of such electroretinography changes.

An outbreak of Pseudomonas aeruginosa postoperative endophthalmitis caused by contaminated intraocular irrigating solution

Journal Article An outbreak of Pseudomonas aeruginosa postoperative endophthalmitis caused by contaminated intraocular irrigating solution Get access Witaya Swaddiwudhipong, Witaya Swaddiwudhipong ∗ 1Department of Community and Social Medicine, Mae Sot General Hospital, Tak 63110 Thailand ∗Author for correspondence. Search for other works by this author on: Oxford Academic PubMed Google Scholar Thasaporn Tangkitchot, Thasaporn Tangkitchot 2Department of Ophthalmology, Mae Sot General Hospital, Tak 63110, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Narumol Silarug Narumol Silarug 3Field Epidemiology Training Programme, Division of Epidemiology, Ministry of Public Health, Bangkok 10200, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 89, Issue 3, May-June 1995, Page 288, https://doi.org/10.1016/0035-9203(95)90545-6 Published: 01 June 1995 Article history Received: 12 December 1994 Accepted: 04 January 1995 Published: 01 June 1995

Corneal Edema from an Intraocular Irrigating Solution Containing Benzalkonium Chloride

AbstractAn intraocular irrigating solution developed in India (Irrisol) has been reported to cause immediate corneal edema when used during cataract surgery. The purpose of this study was to evaluate this intraocular irrigating solution for endothelial toxicity and compare it to balanced salt solution (BSS), a similar irrigating solution used in the United States. Human and rabbit corneas were mounted for in vitro specular microscopy and endothelium perfused with Irrisol and BSS.The results of this study showed that Irrisol caused immediate corneal swelling, with marked destruction of the corneal endothelial cells when observed with scanning and transmission electron microscopy. Further analysis showed that the Irrisol had a lower surface tension (35 dynes/cm) compared to BSS (73 dynes/cm). High-performance liquid chromatographic (HPLC) analysis confirmed that the lower surface tension and the endothelial damage were due to the addition of benzalkonium chloride (BAC) (0.009%) in the Irrisol intraocular ir...