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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M AY 2 0 1 4
T
here's a tremendous amount of equipment in ophthalmol-
ogy that you need to very carefully clean and maintain,
and scrupulous attention to detail is vital. Here are 8 tips
that can prolong the lives of instruments, protect patients
from harm and avoid expensive repair bills.
1. Clean and flush thoroughly. Ophthalmic surgeons
nationwide got a big wakeup call a few years ago, when numerous
cases of toxic anterior segment syndrome (TASS) suddenly began
cropping up in patients who'd had cataract surgery. Almost unheard of
before 2000, the condition became a needle in a haystack as experts
tried to figure out what was causing it.
The search for the cause of TASS eventually put inadequate cleaning
practices under the microscope. Instruments might have looked to the
naked eye as if they were being adequately cleaned before being auto-
claved, but minute remnants were sometimes left behind, particularly
in cannulated instruments. And when endotoxins were introduced
into the next patient's eye, they were released, causing the dangerous
inflammatory reaction.
Further complicating the issue was that sometimes the solution
was part of the problem — meaning sediment from the soap or solu-
tion used to wash instruments wasn't always being adequately
rinsed. One result is that to this day there's still a divide among pro-
fessionals as to whether you should clean instruments with water
only, or whether it's better to use a detergent cleanser.
This much is clear: If you're using a detergent, it's absolutely essential
that it's meant for ophthalmic instruments, that it has the right alkalini-
ty, that you follow manufacturer's directions, and that you rinse it, rinse
it, and rinse it again, to make sure everything is out of your cannulas.
Using an automated rinse system is a good way to flush handpieces and
O P H T H A L M O L O G Y
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