Toxic effects of detergents on the corneal endothelium
R. M. Nuyts, H. F. Edelhauser, E. Pels and A. C. Breebaart
Department of Ophthalmology, University of Amsterdam, The Netherlands.
Eighteen patients developed a toxic endothelial cell destruction syndrome
following normal intraocular surgery, caused by a detergent residue
originating from irrigating cannulas. The residue occurred after the
concentration of a detergent solution has been increased from 0.4% to 4%,
in combination with insufficient cleaning of the cannulas. Mass
spectrometric analysis revealed the detergent to contain a nonionic
ethoxylated fatty alcohol (6% vol/vol). Quantitative endothelial vital
staining and in vitro corneal endothelial perfusion demonstrated
endothelial toxic effects at the 1% and 0.06% level for the detergent and
the pure ethoxylated fatty alcohol, respectively. Permeability studies
showed that the toxic effects occurred as a result of endothelial barrier
breakdown.
