Phaco Training: Need to Autoclave RL/BSS/Visco?

By | June 2, 2015

There are some who strongly advocate autoclaving Ringer Lactate, Balanced Saline Solution and visco elastics

Some never do

Let us what different doctors have to say:

View 1
I autoclave everything including viscoelastic(sodium hyaluronate also),gloves,BSS,syringe-needle. I believe that Autoclaving is the important thing in surgery. I heated somebody saying in conference that if Autoclaving is proper you can do surgery under tree.

View 2

I have always autoclaved ringer and visco. No harm even if

no proven study showing benefits.

View 3

Dear Group,

there is a good degree of ritualism, bordering on irrationality, in many of

our actions: we autoclave some, but not other items used during the course

of surgery. On the one hand, autoclave Ringers, if in glass bottles, but

not if in plastic bottles, autoclave visco if in in glass bottles, but not

pre filled syringes or sodium hyaluronate syringes, we dont autoclave IV

Sets, disposable syringes, for that matter, IOLS and injectors..

Why be selective about autoclaving?

A better option would be to buy items direct from the distributor WITH BILL

AND BATCH NUMBER. that way, the supplier may also be held responsible for

any problem. and, if any brand gives trouble, share the information with

everybody after maintaining proper documentation of the complaint and the

response, or the lack of it. Big firms are notorious for not following up

complaints, but they are certainly uncomfortable with bad publicity.

View 4

Pre-filled syringes can be autoclaved once, only the plunger becomes little

loose. Gloves can be autoclaved with the folded paper in which they are

packed. And accusing the manufacturer and bringing him to book AFTER an

unfortunate event may not be a better option than doing precautionary

autoclaving! That of course is my personal opinion!


I also agree that we must reautoclave RL glass bottles whatever the make
may be. We are doing it routinly .It takes extra time & effort but worth
it. Only care shuold be taken *not to release the steam immediately* by
opening the release valve ,but let it cool itself overnight otherwise the
bottle might explode ( one bottle bust in my hands when trying to cool it
down fastly under the tap luckly my eyes escaped the injury ) So plan it
for overnight
I have seen a sealed RL bottle having fungus & still maintaing the vacuum
when checked with insertion of needle..If you want a detail of steam
sterlisation se this video


Wasting time & enegy on, Visco,Blue dye is worth it rather than having
sleepless nights afterwards Injections.Onlly HPMC PFS Inj. get litter
more liquid after autoclaving

View 5

I just read your post on google groups about autoclaving. sir, 31 years
and no infection is a mentionable achievement.

can you please share your experiences and techniques with us.
do you autoclave RL or BSS. Infact what do u use RL or BSS?
do u autoclave visco as well.
do u use different sets of instruments for different patients in multiple OT
do u patch the patient after cataract surgery or do topical surgery and
start immediate drops. if so what is your ttmt regime after cataract and
pterygium surgery.
do u give subconjuctival injection or intracameral injections if so which
antibiotic and steroid do u use.
do u use lignocaine block or lignocaine with bupivacaine. how much of
block do u give

there are many questions but the above ones are more important.

kindly can you share your experience with us young ophthalmologists so that
we also can learn from your experiences.

View 6
i completely agree with Dr. C.V. Gopala Raju. we do Auto Clave every ringer

lactatate glass bottle and visco elastics since 15 years we never

observed and chemical reaction or tass. multiple times in the past we

observed fungus like material in the bottles even from reputed companies.

earlier we have had bad experiences and after that we made it a routine to

Auto Clave RL Bottles anred visco elastics i think it is very safe procedure

View 7

It may be of some use to Autoclave the consumables but remember, if the

fluids are having fungus/bacteria then autoclaving may kill viable microbes

but pyrogenicity will remain.

View 8

According to the Pharmacopoeia standards glass containers are classified in to 3 varities, Type 1- highly resistant boro slicate glassType 2- internally treated or dealkalized soda-lime glass containersType 3-standard, untreated soda-lime glass. All medical glass containers are supposed to be type 2 only were the internal alkali from the glass is removed by certain dealkalized process, hence the ph of the solution is not changed during heating or other chemical reaction.Hence it is important to check if the RL bottles are of medical grade. Most of the RL bottles / BSS bottles are not so. Hence if the RL/BSS are packed in Type 3 Glass containers and heated the resulting solution becomes more alkaline. The ph of RL is 6.5( still termed as alkalizing solution) and the ph of Aqueous is 7.5-7.6, . One has to check the ph of RL after autoclaving to ensure that the bottles are of Type 2 grade.

View 9

Autoclaving glass bottles can loosen the rubber cork. Once the bottle cools
down, it can suck in room air, along with bacterial and fungal spores. We
cant use it hot just out of autoclave can cause thermal damage. Better
to use ophthalmic irrigation fluid from international brands. We shall have
to believe in something at least.


I completely agree with Dr.C.V. Gopal Raju and it is our routine to Auto
Clave every ringer lactate glass bottle and all visco elastics since 15
years. we never found any chemical reaction or tass and i think it is very
safe .we found in multiple occassions fungus like material in the RL
bottles even from reputed companies and we have had one or two bad
experiences earlier so we made ita routine to Auto Clave RL Bottles and
visco elastics since then

View 10

I agree cent per cent with Dr.Dhaval Raijiwalla.In last 31 years of my
practice I have operated intraocular surgeries in Ob.Gyn.,ENT,Gen.Surgery
O.Ts.,even in a old
mud house equipped with a pedestal fan starting with simple intracap.with 5
interrupted 8/0 suture to ultra modern phaco microsurgery.NO SINGLE CASE OF
ENDOPH.TILL DATE believe it or not! Credit goes to perfect autoclaving
which I am sure is the only key to avoid post
infection.Offcourse appropriate pre /per and post op.precautions do count.
Epoxy or other types of expensive flooring and wall coating,air
curtains,Hepa filters,U.V. air cleaners,intra cameral inj.etc.are just
adjuvants .

View 11

I have been following the autoclaving ringer lactate pros and cons across

the country opinion for some time now Endophalmitis is 1: 3000 incident
and we may think any of our practises work.It is important medicolegally
that we use fluids for intraocular use.Baxter are the fluid people and
Alcon sells its BSS for intraocular use at very affordable prices no
financial interest but these double polypacs have been used by us for more
than 60000 paid surgeries every year for the last few years with excellent

View 12


I get the bulk purchase and do culture of the viscoelastic batch, BSS

batch, and once a month after ot is fumigated and closed for 48 hours,

culture is sent from different places in ot. If negative we go ahead. It

keeps you safe and helps you to take any preventive measures if required.