In a move to provide guidelines for better ophthalmic surgical outcomes, Emory Eye Center's Henry F. Edelhauser, PhD, director of research, along with the Ad Hoc Task Force on Cleaning and Sterilization of Intraocular Instruments, met last fall to tackle the difficult issue of ophthalmic instrument cleaning and sterilization.
The results of that seminal meeting are reported in "Anatomy of a TASS Outbreak" in the March issue of the Journal of Cataract and Refractive Surgery (Vol. 33, no. 3).
The new guidelines are established to prevent future complications for many ophthalmology surgery patients.
In the past few years, researchers and ophthalmologists have noted outbreaks of toxic anterior segment syndrome (TASS). This condition can cause blurry vision immediately after cataract surgery and can be followed within hours by corneal edema, diffuse iris damage and trabecular meshwork damage [which filters the aqueous fluid within the eye and controls its flow].
Dr. Edelhauser began his studies on this at Emory several years ago. Recent increases in the cases of TASS have kept concerns by researchers high.
When ophthalmic instruments used on eye surgeries are not properly sterilized, an outbreak of TASS can occur. These front-of-the-eye surgeries include routine cataract and glaucoma procedures, among others. It is difficult to clean ophthalmic instruments because they are small and have small bores (holes), making cleaning all the more difficult. Further, any substances that come in contact with these instruments can create build-up. Detergents can leave residues as a result of inadequate rinsing. Even ultrasound waterbaths have lead to possible endotoxin contamination, causing secondary anterior segment (front of the eye) inflammation.
There have been sporadic clusters of TASS at free-standing surgical centers - as well as multiple small outbreaks involving only a few patients. Hospital surgeries seemed to fare somewhat better, but the reason or reasons for the outbreaks remained unclear.
In February 2006, TASS outbreak numbers changed dramatically, and Dr. Edelhauser, along with Nick Mamalis, MD, of the University of Utah's Moran Eye Center, co-chaired a task force to tackle the problem with a grant from the American Society of Cataract and Refractive Surgery (ASCRS).
The task force, comprised of ophthalmologists, ophthalmic researchers, ophthalmic nursing personnel, CDC and FDA experts, epidemiologist Walter Hellinger, MD, (Mayo Clinic) and representatives from major ophthalmic pharmaceutical companies, established protocols to eliminate potential causes of TASS. The report, "Recommended Practices for Cleaning and Sterilizing Intraocular Surgical Instruments" was prepared in February.
"It is our hope that this task force has provided insight and guidance for ophthalmologic instrument cleaning so that outbreaks of TASS will be a thing of the past," says Dr. Edelhauser. "The talent on the 20-member task force was considerable, and this first step should have a positive effect on our surgical outcomes in the future."
Weighing in from the clinical perspective, Emory Eye Center surgeon Anastasios Costarides, MD, PhD, says, "A successful surgical outcome is dependent upon the coordinated effort of staff ranging from those who sterilize the instruments to the surgeon performing the procedure. The TASS outbreaks have emphasized the importance of proper sterilization techniques. Ophthalmic surgical instruments need not be free of infectious agents alone, but of viscoelastics and detergents as well, " he states. "I commend Dr. Edelhauser, Dr. Mamalis and the members of the TASS outbreak task force for their work in enlightening us on the risks and remedies of TASS."
The Emory Eye Center includes the Department of Ophthalm ology, part of the Emory School of Medicine, its clinical sector and all aspects of research. Ranked in the top 20 of the U.S. News & World Report's annual survey of the nation's best eye centers, Emory Eye Center remains in the top ten of the peer-evaluated Ophthalmology Times survey. The South's first corneal transplant was performed in Georgia in 1947; its refractive surgery trials were conducted in the 1980s, and it remains at the forefront of many national clinical trials, including those on macular degeneration and glaucoma.