priate for ophthalmic surgery. So they developed evidence-based,
peer-reviewed, ophthalmology-specific cleaning and sterilization
guidelines.
Dr. Mamalis, professor of ophthalmology, co-director of
Intermountain Ocular Research Center, and director of ocular pathol-
ogy at University of Utah's John Moran Eye Center, says a key aspect
of the new guidelines involves enzymatic detergents. Many mistakenly
believe ophthalmic instruments treated with enzymatic detergents are
clean and sterile, but the researchers found that microscopic enzyme
residues the detergents leave behind on the instruments can cause
TASS. It would help if instrument manufacturers validated cleaning
methods that don't require enzymatic detergent, says Dr. Mamalis,
who adds that a more thorough cleaning regimen that adheres to the
guidelines can alleviate the need for using enzymatic detergents
entirely.
Likewise, more thorough cleaning can obviate the need to use ultra-
sound water baths for cleaning bulk material off of ophthalmic instru-
ments. Research shows that these baths, if not cleaned properly after
each use, can build up with gram-negative bacteria that leaves a heat-
stable endotoxin residue that can cause TASS, says Dr. Mamalis.
Due to the exacting nature of cleaning and sterilization required to
avoid TASS, single-use instruments present an attractive option. "In
areas where you can't adequately ensure that an instrument's going to
be properly cleaned, it's definitely recommended that you use single-
use instruments — cannulas especially, and especially if you're using
them to inject [viscoelastic] into the eye during the surgery, because
it's very difficult to get all of the residual [viscoelastic] out of the can-
nulas," says Dr. Mamalis. "That could cause potential problems such
as inflammation and TASS." But he adds that a single-use strategy
across the board wouldn't be practical or cost-effective. Replacing a
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