The edition · Ophthalmology
Routine high-level disinfection of tonometer tips and clinic lenses is not needed, a multisociety task force concludes
A position paper backed by the American Academy of Ophthalmology finds no evidence that reusable ocular-surface devices spread sight-threatening infection, corneas from donors with diabetes did as well as any in DMEK, and DMEK carried less post-keratoplasty glaucoma than DSAEK.
The edition in brief
A multisociety task force (Ophthalmology, 9 October 2026) found no published evidence that Goldmann tonometer tips, gonioscopy or laser lenses transmit sight-threatening infection, or that high-level disinfection prevents transmission better than lower-level methods; it recommends against routine high-level disinfection in clinical care, keeping it discretionary after use in suspected infection. Most of over 1,000 surveyed ophthalmologists used alcohol wipes, and many using chemical disinfection reported ocular surface toxicity or device damage. A secondary analysis of a US randomised DMEK trial (JAMA Ophthalmology, 8 October 2026) in 1,421 eyes found 1-year graft success of about 93-97% regardless of donor HbA1c or glycation markers. A meta-analysis of 33 studies and 5,235 eyes found de novo glaucoma in 3% after DMEK vs 11% after DSAEK and ocular hypertension in 9% vs 34%, although certainty was low and steroid exposure contributed. Pearl: check pressure at every visit while a patient is on topical steroids after keratoplasty.
Corneas from donors with diabetes did as well in DMEK, whatever the donor's HbA1c
Corneas from donors with diabetes can be used for DMEK without extra testing for diabetes severity.
Glaucoma and ocular hypertension were less frequent after DMEK than DSAEK
Pressure rises are common after endothelial keratoplasty; DMEK carries less risk, but every patient needs pressure checks.
Intraocular pressure ran slightly lower on warmer days in treated glaucoma
A small winter rise in pressure in stable glaucoma may reflect temperature; confirm before escalating treatment.
Check pressure at every visit while a keratoplasty patient is on topical steroids
Every visit on post-keratoplasty steroids is a pressure check.
Routine high-level disinfection of tonometer tips and clinic lenses is not required, says a multisociety task force
Routine high-level disinfection of tonometer tips and diagnostic lenses is not required in the task force's view; reserve it for higher-risk cases such as suspected infection.
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