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Infection risks
Making an incision in the sealed, sterile eye opens the risk of infection. Endophthalmitis is particularly severe, devastating to vision and
demanding urgent treatment.
Dr. Cunningham advises postponing cataract surgery on any patient
suffering an upper respiratory infection in order to avoid the transfer
of bacteria. "Though it has more to do with the way the eye is
prepped," he says. "In a cataract wound, in all probability infection is
coming from bacteria on the eyelids and eyelashes." This is where the
surgical staff, povidone-iodine and meticulous intraoperative irrigation makes a big difference.
Dr. Yeh says she gets even more meticulous. "All the cases of
endophthalmitis I ever saw came from just 1 rural hospital," she
recalls. "I found that they were just prepping the lids and lashes." She
recommends dripping diluted povidone-iodine from a syringe directly
onto the eye surface and not rinsing.
In addition to prepping, don't neglect other stalwart infection prevention practices such as ensuring your instrument sterilization
process meets strict standards; using sterile single-use scalpels, preloaded IOL injectors and other instruments to eliminate cross-contamination; and administering prophylactic antibiotics. Dr. Vold recommends injecting vancomycin into the corneal incision, adding the drug
to BSS or using a topical form. "We're aggressive about it," he says.
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