NO ENZYME CLEANERS Detergents may contain exotoxins that can lead to TASS, say 3 major ophthalmic groups.

Enzymatic cleaners are likely to do more harm than good when used to clean ophthalmic instruments, say 3 major ophthalmic groups in a joint statement issued this week.

Though some ophthalmic instrument manufacturers recommend using enzymatic cleaners, detergents often contain exotoxins that aren't denatured by autoclave sterilization, say the American Society for Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO) and the Ophthalmic Outpatient Surgery Society (OOSS). They add that corneal endothelial toxicity and TASS (toxic anterior segment syndrome) have both been associated with the use of enzymatic detergents.

The purpose of enzymatic detergent is to remove bulk biomaterial from surgical instruments. Because intraocular instruments acquire little bioburden during surgery, prompt manual rinsing and cleansing after surgery should be sufficient to remove bioburden, they say. They also caution those who continue to use enzymatic detergents to carefully follow instructions for proper dilution, and to use sterile distilled or sterile deionized water for the final instrument rinse.

The bottom line? Based on documented risk of TASS, and with no proven benefit for endophthalmitis prevention, enzymatic detergent shouldn't be required for routine decontamination of intraocular instruments, say the groups.

Jim Burger