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Effects of Enzymatic Sterilization Detergents on the Corneal Endothelium
Chirag Parikh, BA;
Brian D. Sippy, MD, PhD;
Daniel F. Martin, MD;
Henry F. Edelhauser, PhD
Arch Ophthalmol. 2002;120:165-172.
Objective To evaluate the potential of enzymatic detergents to cause endothelial
damage and anterior segment inflammation.
Methods Paired rabbit corneas were mounted in an in vitro specular microscope.
Endothelia were perfused either with the sterile irrigating solution BSS Plus
(Alcon Laboratories Inc, Ft Worth, Tex) (control) or 0.1%, 0.4%, or 1.0% Medline
Enzymatic Detergent (Medline Industries Inc, Mundelein, Ill) in BSS Plus.
Swelling rates were determined by regression analysis. Human endothelia were
perfused using 1.56% detergent. All corneas were fixed for scanning electron
microscopy (SEM) and transmission electron microscopy (TEM). Endothelial permeability
was determined following perfusion of 0.78% detergent. Finally, in vivo intracameral
injections with 1.56% or 3.9% detergent were performed to evaluate clinical
changes and to correlate with histopathologic analysis.
Results Dose-related corneal swelling rates were observed. Digital specular
micrographs revealed greater endothelial cell damage when perfused with 1.0%
detergent. The TEM of endothelia exposed to 1.0% solutions demonstrated abnormal
vacuolization and dilated extracellular spaces, which manifested as an increased
corneal permeability to 3 to 4 times that of controls. Human corneas swelled
comparably to rabbit corneas but demonstrated increased sensitivity when evaluated
by TEM and SEM. Histopathologic analysis after intracameral injection revealed
thickened corneas with fewer endothelial cells and irises with increased inflammatory
and fibrinous responses compared with controls.
Conclusions Medline Enzymatic Detergent causes a dose-dependent corneal swelling,
ultrastructural damage, increased corneal permeability, and increased inflammatory
response in the iris after intracameral injection.
Clinical Relevance Failure to adequately rinse the detergent from surgical instruments
may result in corneal edema and intraocular inflammation.
From the Department of Ophthalmology, Emory Eye Center, Atlanta, Ga.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
The Balance between Corneal Transparency and Edema The Proctor Lecture
Edelhauser
IOVS 2006;47:1755-1767.
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