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Sir, We read with great interest the article by Leslie _et al_,1 since we have also been dealing with a cluster of endophthalmitis at our tertiary care centre in South India. In all, 10

patients (0.18% of 5706 procedures) developed culture-proven postphacoemulsification endophthalmitis between January and August 2003, following surgery by seven surgeons, at three dedicated

eye operation theatre complexes. No breach of our sterilization protocols was noted. Since the rate of infection in nonphacoemulsification cataract surgeries during the same time period was

0.02% (1 of 4335 surgeries), suspicion was directed at the phacoemulsifiers and associated equipment. We hence performed the following experiments. After routine scrubbing and gloving,

sterile Ringers lactate solution (Sri Krishna Keshav Laboratories, Gujarat, India) was flushed through the irrigation and aspiration lines of the autoclaved phacoemulsification and IA

handsets. The washings were sent for microbiological analysis, and were centrifuged (Remi Laboratory Centrifuge, India) for deposits. In the seven pairs of phacoemulsification and IA

handsets studied, only the irrigation tubes were flushed in two sets, thus providing 24 samples. Although fluid samples taken directly from the bottle were sterile, the flushings were

culture positive in 16 instances (_Alkaligenes fecalis_ in one and _Acinetobacter calcoaceticus_ in the rest). Similar organisms were isolated in 10 eyes with postphacoemulsification

endophthalmitis (_A. fecalis_ in five and _A. calcoaceticus_ in two, _pseudomonas stutzeri_ in two and _pseudomonas aeruginosa_ in one eye). The sediments from the washings revealed the

presence of deposits, 5–40 _μ_m in size, which were needle shaped and suggestive of lens matter. To further confirm the presence of such debris in the handsets, we procured a flexible

fibreoptic microendoscopic probe (Storz) with a diameter of 1 mm, to visualize the inner surface of the irrigation and aspiration tubes of five phacoemulsification handsets. Irregular

plaque-like deposits were observed in all aspiration tubes, mostly in the middle one-third segment. Similar deposits were also noted at the junction of the irrigation and aspiration tubes,

in one of the probes. We thus concur with Leslie _et al_1 that deposits in the phacoemulsification and IA handsets may contribute to postoperative inflammation, not all of which may be

sterile. The use of a fibreoptic probe is a useful aid in the investigation of such epidemics of postphacoemulsification endophthalmitis. REFERENCES * Leslie T, Aitken DA, Barrie T, Kirkness

CM . Residual debris as a potential cause of post phaco-emulsification endophthalmitis. _Eye_ 2003; 17: 506–512. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS

AND AFFILIATIONS * Medical Research Foundation, 18 College Road, Chennai, Tamil Nadu, India M Baskaran, S K Rao & P J Ramana Kumar * Vision Research Foundations, 18 College Road,

Chennai, Tamil Nadu, India L Vijaya & H N Madhavan Authors * M Baskaran View author publications You can also search for this author inPubMed Google Scholar * S K Rao View author

publications You can also search for this author inPubMed Google Scholar * P J Ramana Kumar View author publications You can also search for this author inPubMed Google Scholar * L Vijaya

View author publications You can also search for this author inPubMed Google Scholar * H N Madhavan View author publications You can also search for this author inPubMed Google Scholar

CORRESPONDING AUTHOR Correspondence to M Baskaran. ADDITIONAL INFORMATION Proprietary Interest — the authors have no proprietary interests in the material presented. RIGHTS AND PERMISSIONS

Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Baskaran, M., Rao, S., Kumar, P. _et al._ Postphacoemulsification endophthalmitis — role of residual debris in the handsets used

for surgery. _Eye_ 19, 115–116 (2005). https://doi.org/10.1038/sj.eye.6701484 Download citation * Published: 16 April 2004 * Issue Date: 01 January 2005 * DOI:

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