News Releases

April 5 , 2007

Emory Ophthalmology Researcher Collaborates for Guidelines for Optimal Surgical Outcomes

(ATLANTA) In a move to provide guidelines for better ophthalmic surgical outcomes, Emory Eye Center’s Henry F. Edelhauser, PhD, director of research, along with a selected committee of professionals— the Ad Hoc Task Force on Cleaning and Sterilization of Intraocular Instruments— came together last fall at Emory University 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 have the impact of preventing future complications for a number of ophthalmology surgery patients.

In the past few years, researchers and ophthalmologists have noted outbreaks of toxic anterior segment syndrome (TASS), a condition that can cause blurry vision immediately after cataract surgery and can be followed within hours by corneal edema, diffuse iris damage and damage to the trabecular meshwork (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. The problem with cleaning ophthalmic instruments is that they are so small with 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. Their 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.”

Media Contact: Joy H. Bell, jbell@emory.edu, 404-778-3711

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