An Ridiculous Isoxsuprine Conspriracy
8 Throughout the study, at the end of surgery, all eyes were pressurized to a physiologic intraocular pressure, and incisions were hydrated. Each incision was carefully checked for aqueous leakage, either with a cellulose surgical spear or Seidel tested with fluorescein or Betadine solution. Leaky incisions were rehydrated or sutured. During the baseline period from 2002 to 2005 (baseline period), surgeons pressurized eyes and hydrated incisions with plain BSS. Starting in early 2006 (the intervention period), surgeons switched from using plain BSS to using the vancomycin/BSS irrigating solution for eye pressurization and incision hydration. We instructed the scrub technicians to draw up all syringes for these steps from the irrigating fluid. In our operating rooms, there are no syringes with plain BSS on the instrument table, eliminating the possibility of an incorrect syringe being passed to the surgeon. Outpatient topical antibiotics were prescribed by every surgeon throughout the study. From 2002 to 2012, the majority of surgeons prescribed current-generation fluoroquinolones, while others prescribed tobramycin or neomycin/polymyxin/dexamethasone. In late 2012, we noted reports of increasing fluoroquinolone resistance by endophthalmitis isolates,18,30 but good coverage of Gram-positive eye infection isolates with trimethoprim.31 In early 2013, we uniformly switched outpatient antibiotics to polymyxin B/trimethoprim drops four times daily, starting the day before surgery and continuing for a week after surgery. Our retinal surgeons reported endophthalmitis cases (pain, erythema, corneal edema, decreased vision, and panuveitis) to our Infection Control Department. Suspected endophthal-mitis patients received vitreous and aqueous taps for cultures, as well as intravitreal antibiotic injections (vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL or amikacin 400 ��g/0.1 mL). Patients with light perception or worse visual acuity typically underwent pars plana vitrectomy, per the Endophthalmitis Vitrectomy Study protocol.1 Starting in 2005, we queried our electronic health record (HealthConnect, Epic, click here Madison, WI, USA) to ascertain every case of endophthalmitis (International Classification of Diseases, Ninth Edition, ICD-9, 360.0��), regardless of cause. Both authors reviewed each case of endophthalmitis, and those occurring within 6 weeks of surgery, in the operated eye, without other intraocular procedures, trauma, or pathology, were classified as acute postcataract endophthalmitis. The presence or absence of intraoperative complications, including posterior capsule tear and vitreous loss, were recorded by surgeons in the electronic record for every case, as was the lens implant manufacturer, model, and power. Each chart was electronically audited for completeness, and surgeons were contacted to complete any missing data.
