CHICAGO (Reuters Health) Dec 17 – The ice water that some ophthalmologists use to chill laser-assisted in situ keratomileusis (LASIK) lavage fluids may be contaminated with Mycobacterium szulgai and increase a patient's risk of developing M szulgai keratitis.
This finding, presented on Sunday at the 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, was the result of a retrospective study involving 52 patients who underwent a total of 92 LASIK procedures performed by one of two surgeons (Dr. A and Dr. B).
Dr. Gary P. Holmes, from Scott and White Memorial Hospital and Clinic in Temple, Texas, and colleagues found that five of the patients had confirmed postoperative M szulgai keratitis. Two additional patients who had similar corneal lesions that were not cultured were considered probable cases.
Despite performing half as many procedures as Dr. B, all seven cases occurred among Dr. A's group of patients. The only difference between the surgeons' techniques seemed to be that Dr. A used ice water-chilled lavage fluid while Dr. B used un-chilled fluid.
Dr. Holmes' team obtained cultures from several environmental sources and found that the drain from the ice machine used by Dr. A harbored M szulgai. Further analysis revealed that the M szulgai strain isolated was identical to the strain found in the keratitis patients.
"This study began when we received a call from one of the ophthalmologists who was very concerned with the number of patients who had developed keratitis several weeks after he performed a LASIK procedure," Dr. Holmes told Reuters Health. "It turned out that all five of the patients we cultured had exactly the same organism," he added.
"Dr. A was trained by a surgeon in Dallas who chilled his LASIK lavage fluid," Dr. Holmes stated. "There are a few papers in the literature that suggest that chilling the lavage fluid reduces the development of an occasional postoperative complication known as lamellar keratitis," he explained.
"As far as we can tell, M szulgai infection has never been linked to an environmental source," Dr. Holmes noted. "Dr. A was careful not to place the lavage syringe tip in contact with the ice water, but perhaps some droplets from the outside of the syringe entered the patients' eyes," he speculated.
Dr. Holmes believes that "ophthalmologists, and surgeons in general, should probably not use ice water during an operative procedure." There are "no data in the literature that indicate a significant benefit from using chilled saline and, as the current findings show, there may be a significant contamination risk," he stated.
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