Question:
You are assuming bilateral would be very rare (multiplying the rarity by
itself, yes), but bilateral could happen more easily, because the infection
could spread through the bloodstream, for example. And why did the first eye
get it, in spite of the "great" antibiotics?
Answer:
I understand your reluctance to increase risk factors. I'd like to see
the stats for simultaneous bilateral surgery vs two week delay vs three
month delay. Then, the patient can make an informed decision. I have
one person right now that, following unilateral IOL is plano OD and -5D
OS. She can't use spectacles, can't wear contacts, has constant
diplopia and now cannot renew her driver's license, is at risk of
falling and breaking a hip or leg.
This is a very interesting area. Obviously, an internal eye infection or
inflammation is one of the worst possible outcomes of cataract/lens
exchange surgery. I think it can be avoided pretty much completely if
certain safeguards are taken, like 1: pre-op eradication of any ocular
surface or lid inflammations; 2:pre-op use of the latest generation
fluroquinolone, a strong steroid and a NSAID; 3: pre-op meticulous
cleansing, rinsing and sterilization of the eye, lids, adnexa and all
instrumentation; 4: surgical technique that results in a self-sealing
incision that is open less than 15 minutes; 5: the constant infusion of
vancomycin while the eye is open; and 6: positive verification that the
wound is neither leaking nor sucking immediately post-op and on 1 day
post-op, and; 7: post-op meticulous and proper use of the same drugs as
in #2.
I don't think many microbes can stand up to that rigorous a protocol,
and would hope that something like it is or soon becomes the norm.
