EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
February 2013 EW RESIDENTS 75 after phacoemulsification cataract surgery��� with multiple influencing factors, including incision type, surgeon experience, and importantly, intraoperative complications. What is not known is the relative risk of endophthalmitis associated with leaving residual cortex. We suspect that it is quite low. Complete removal of cortex can increase the risk of capsular rupture, which then increases the relative risk of endophthalmitis by 10- to 11-fold.7 Attempted removal of difficult-to-reach pieces of cortex, especially by inexperienced surgeons, may result in multiple entries into the eye, increased duration of surgery, destabilization of the capsular bag, and damage to the corneal wound. These factors can all increase the risk of endophthalmitis. Capsular rupture and loss of zonular support may also lead to the implantation of an anterior chamber intraocular lens, which has long-term implications for patients��� corneal endothelium and their risk of glaucoma. All of these possibilities must be considered when comparing the risk of endophthalmitis associated with complete versus incomplete cortex removal. In conclusion, we are not surprised by the finding that the presence of organic tissue, homogenized lens cortex in stagnant aqueous, encouraged bacterial growth. While we note a few problems with the animal model, we agree that it suggests there may be a slightly higher incidence of sterile and bacterial en- dophthalmitis correlated with the presence of residual cortex. However, we believe that until the clinical benefits of complete cortical removal are better demonstrated to outweigh the risks of intraoperative complications, especially capsular rupture, cataract surgeons need not attempt removal of every last piece of cortex. EW thalmitis in the United States: analysis of the complete 2003 to 2004 Medicare database of cataract surgeries. Ophthalmology 2012;119:914-22. 7. Hatch WV, Cernat G, Wong D, Devenyi R, Bell CM. Risk factors for acute endoph- thalmitis after cataract surgery: a population-based study. Ophthalmology 2009;116:425-30. Contact information Fredrick: dfred@stanford.edu Occu-Flo Punctum Plugs ��� References 1. Lou B, Lin X, Luo L, Yang Y, Chen Y, Liu Y. Residual lens cortex material: Potential risk factor for endophthalmitis after phacoemulsi���cation cataract surgery. Journal of Cataract & Refractive Surgery 2012. 2. Gwon A. The Rabbit in Cataract/IOL surgery. In: Tsonis P, ed. Animal Models in Eye Research. San Diego, CA: Elsevier Ltd; 2008. 3. Tamura M, Monson MC, Davis B, Mamalis N. In���uence of lens cortex on postoperative in���ammation and cellular deposits on surface of intraocular lenses in rabbit eye. Japanese Journal of Ophthalmology 1991;35:194-206. 4. West ES, Behrens A, McDonnell PJ, Tielsch JM, Schein OD. The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001. Ophthalmology 2005;112:1388-94. 5. Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Archives of Ophthalmology 2005;123:613-20. 6. Keay L, Gower EW, Cassard SD, Tielsch JM, Schein OD. Postcataract surgery endoph- Occu-Flo��� Plugs Offer: ��� Easy Insertion ��� A smooth finish which creates immediate patient comfort ��� High tolerance by patients ��� Easy removal if necessary Occu-Flo��� Relieves Dryness and Discomfort Due To: ��� ��� ��� ��� Post Surgical Complications Seasonal Allergies Medication Side Effects Contact Lens Usage Available Preloaded Sterile on Insertion Handle (2/box) or Nonsterile Bulk Informed continued from page 72 USP-3004 Editors��� note: Dr. Ksiazek has no financial interest related to this article. Dr. Pineda has financial interests with Amgen (Washington, D.C.) and Angiotech (Vancouver, British Columbia). Contact information Pineda: Roberto_Pineda@MEEI.HARVARD.EDU Ksiazek: sksiazek@bsd.uchicago.edu .460 1.480 0.660 Large Medium .410 1.330 USP-3006 USP-3005 Small .510 1.580 0.810 1.020 www.usiol.com 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 859-259-4925, 800-354-7848 Fax: 859-259-4926 E-Mail: usiol@aol.com