Retention of corneal epithelial cells following Goldmann tonometry: implications for CJD risk

Aims: To assess the adequacy of current decontamination methods for the Goldmann tonometer in the context of variant Creutzfeldt-Jakob disease (vCJD). Methods: Reusable Goldmann tonometer prisms were used to perform applanation tonometry on different groups of patients. Following tonometry, retained...

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Bibliographic Details
Published in:British journal of ophthalmology 2003-05, Vol.87 (5), p.583-586
Main Authors: Lim, R, Dhillon, B, Kurian, K M, Aspinall, P A, Fernie, K, Ironside, J W
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alcohol
Analysis of Variance
applanation tonometry
Biological and medical sciences
Bovine spongiform encephalopathy
Cell Count
Cellular biology
Clinical medicine
Clinical Science
Clinics
cornea
Creutzfeldt-Jakob disease
Creutzfeldt-Jakob Syndrome - transmission
cytology
decontamination
Disinfection
Epithelial Cells
Epithelium, Corneal - cytology
Equipment Contamination
Equipment Reuse
Glaucoma - therapy
Humans
Investigative techniques, diagnostic techniques (general aspects)
Laboratories
Medical sciences
Middle Aged
Ophthalmic Solutions - administration & dosage
Ophthalmology
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Patients
Performance evaluation
Sodium
Sodium Hypochlorite
Tonometry, Ocular - instrumentation
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Summary:Aims: To assess the adequacy of current decontamination methods for the Goldmann tonometer in the context of variant Creutzfeldt-Jakob disease (vCJD). Methods: Reusable Goldmann tonometer prisms were used to perform applanation tonometry on different groups of patients. Following tonometry, retained materials were collected from the tonometer prism head and examined using cytological methods. The used tonometers were subjected to a series of conditions to evaluate their effect on the residual cell numbers found on the tonometer heads. These included wiping alone and wiping or washing followed by disinfection of the tonometer prism. The effect on cell counts of drying the prism overnight was studied, as well as drying overnight and then wiping and disinfecting. All disinfections were performed with sodium hypochlorite (0.05% w/v). Results: The cytology specimens of 69 patients were studied. Patients using eye drops regularly desquamated significantly more corneal epithelial cells with Goldmann tonometry than patients not using regular eye drops. The mean number of cells was 156 (range 0–470) for patients using eye drops and 14 (4–57) for patients not using eye drops (p = 0.004). Wiping or washing the tonometer head reduced the cell number significantly but neither method completely eliminated cells. The two methods were not significantly different (p=0.3). Drying left a large number of cells (23–320 cells). Conclusions: Retained corneal epithelial cells, following the standard decontamination routine of tonometer prisms, may represent potential prion infectivity. Manual cleaning was the most important step in reducing epithelial cell retention.
ISSN:0007-1161
1468-2079
DOI:10.1136/bjo.87.5.583