according to Dr. Shorstein. He says the proper
flushing and cleaning of instruments before
sterilization is an important step in reducing
the risk of toxic anterior segment syndrome
(TASS), but from a purely epidemiologic
standpoint, disposable equipment probably
offers the easiest and safest way to avoid
potential problems caused by bioresidue that
remains on reusable instruments.
"But each surgery center must perform a
cost-benefit analysis, to decide which instru-
ments should be reusable and which they
should purchase as disposable," he says.
Dr. Shorstein points out that research on
TASS and bilateral same-day cataracts per-
formed by ophthalmologists Nick Mamalis,
MD, and Steve Arshinoff, MD, FRCSC, respec-
tively, recommend the use of disposables for
small-lumened instruments such as I/A tips.
Handpieces with larger lumens are easier to
rinse to ensure the total washout of residue
per manufacturers' recommendations, so it
may be less important to go with disposables,
according to Dr. Shorstein.
Intraocular antibiotics work in the hours
after surgery, but it's also important for the
wound to remain sealed when the level of
antibiotics in the anterior chamber falls below
the minimal inhibitory concentration of the
potentially infectious organism, says Dr.
