Sterile Endophthalmitis in Vitrectomised Eyes due to Suspected Heat Resistant Endotoxins in the Infusion Fluid

Abstract

Purpose: To report on to the possibility of development of severe postoperative sterile endophthalmitis due to heat-resistant bacterial endotoxins in commercially available infusion fluids Methods: A case study of 4 eyes that had previously undergone vitreoretinal surgery, which developed clinical endophthalmitis within 18 hours of surgery and two eyes that had vitreous surgery with intraocular gas and did not develop clinical endophthalmitis following intraocular surgery on three consecutive operative days Results: The vitreous samples were sterile, both for bacteria and fungi. The only common supply in all cases was a new batch of Ringer′s lactate infusion fluid. Though the Ringer′s lactate solutions in the same batch were also sterile, the infusion fluids contained abnormally high levels of bacterial endotoxins detected by gel clot method. Conclusion: Commercially available infusion fluid may be sterile, yet contain endotoxins from killed bacteria. This could cause postoperative sterile endophthalmitis.

Keywords

• Sterile endophthalmitis
• postoperative
• bacterial endotoxins