Patching to prevent postoperative endophthalmitis
The white paper by Nichamin et al.1 considers several possible associations between clear corneal cataract incisions and postoperative endophthalmitis. In his letter, Faulkner2 suggests the additional possibility of topical anesthesia playing a part by allowing forced blinking and contraction of the extraocular muscles in the very early postoperative period, thereby fostering the entry of extraocular fluid into the anterior chamber.
With the adoption of topical anesthesia came the practice of leaving the eye unpatched, although sometimes protected with a shield. The combination of topical anesthesia and abandoning the patch may have fostered the increasing incidence of postoperative endophthalmitis. Through a reduction in blinking, patching the eye for 24 hours might offer a simpler solution than returning to block anesthesia or suturing the wound.
1. Nichamin LD, Chang DF, Johnson SH, et al. ASCRS White Paper: what is the association between clear corneal cataract incisions and postoperative endophthalmitis? J Cataract Refract Surg. 2006;32:1556-1559.
© 2007 by Lippincott Williams & Wilkins, Inc.
2. Faulkner HW., 2006. Association between clear corneal cataract incisions and endophthalmitis [letter], J Cataract Refract Surg, 33, 562.