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Surgical Glove-Associated Diffuse Lamellar Keratitis

Hoffman, Richard S MD*; Fine, I Howard MD*; Packer, Mark MD*; Reynolds, Tony P COT; Bebber, Cherie Van RN

doi: 10.1097/01.ico.0000154379.75119.ba
Clinical Sciences

Purpose: To demonstrate a potential cause of a prolonged epidemic of diffuse lamellar keratitis (DLK).

Method: This retrospective review analyzed an epidemic of diffuse lamellar keratitis over a 3-year period in a single surgery center. Altering the brand of surgical gloves used during surgery was associated with an elimination of the DLK epidemic. Optical microscopy, scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), and Fourier transform infrared (FTIR) spectroscopy were performed on both brands of surgical gloves to allow for comparisons and determine possible surface contaminants responsible for the DLK outbreaks.

Results: The incidence of DLK during the epidemic ranged from 2% to 38% on a quarterly basis for the 3-year period. A change in the brand of surgical gloves resulted in a cessation of DLK. Surface analysis of both brands of gloves revealed extensive silicone oil contamination on the internal and external surfaces of the DLK-associated gloves and insignificant amounts of silicone oil on the external surface of the DLK-free gloves.

Conclusion: Silicone oil contamination of surgical gloves appears to be associated with epidemic DLK.

From the *Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; and †Oregon Eye Surgery Center, Drs Fine, Hoffman & Packer, LLC, 1550 Oak Street, Suite 5, Eugene, Oregon.

Received for publication July 14, 2004; revision received October 1, 2004; accepted October 21, 2004.

Expenses for independent laboratory analysis of the surgical gloves were compensated for retroactively by an educational grant from Cardinal Health, Inc.

None of the authors has any financial interest in any of the products mentioned in this manuscript.

Reprints: Richard S. Hoffman, Oregon Eye Surgery Center, Drs Fine, Hoffman & Packer, LLC, 1550 Oak Street, Suite 5, Eugene, Oregon 97401 (e-mail: rshoffman@finemd.com).

© 2005 Lippincott Williams & Wilkins, Inc.