Is room temperature Balanced Salt Solution (BSS) safe for cataract surgery?

From the Guidelines

Room temperature Balanced Salt Solution (BSS) is generally not recommended for cataract surgery, and it should ideally be warmed to approximately body temperature (around 37°C or 98.6°F) before use in ophthalmic procedures. Using cold BSS during cataract surgery can cause patient discomfort and potentially lead to complications such as endothelial cell damage, corneal edema, and increased risk of toxic anterior segment syndrome (TASS) 1. The temperature difference between room temperature solution and the eye can create thermal shock to delicate ocular tissues. Additionally, cold irrigation fluid may cause patient discomfort, increased pain sensation, and even trigger vasovagal responses in some patients.

Some key points to consider when using BSS in cataract surgery include:

• The importance of warming the solution to body temperature to minimize the risk of complications
• The potential for cold BSS to cause patient discomfort and increase the risk of complications
• The use of warming cabinets or fluid warmers to bring BSS to the appropriate temperature before surgery
• The recommendation to allow BSS to reach room temperature if warming equipment is not available, rather than using refrigerated solution

It is also worth noting that the provided evidence does not directly address the use of room temperature BSS in cataract surgery, but rather discusses its use in refractive surgery 1. However, the principles of minimizing thermal shock and preventing complications are still relevant, and the recommendation to warm BSS to body temperature remains the ideal practice for optimal surgical outcomes and patient comfort.

From the Research

Room Temperature BSS for Cataract Surgery

• The safety of using room temperature Balanced Salt Solution (BSS) for cataract surgery has been evaluated in several studies 2, 3, 4, 5.
• A study published in the Journal of Cataract and Refractive Surgery in 2000 found that the solution temperature did not affect any parameter, including pupil diameter, corneal endothelium, and corneal pachymetry during and after phacoemulsification 2.
• Another study published in Clinical Ophthalmology in 2021 compared the postoperative effect on central retinal macular thickness of a cooled irrigating eye solution used during cataract surgery, and found that the use of a cooled irrigating eye solution may be beneficial in preventing the possible development of postoperative macular thickening, but room temperature BSS was not found to have a significant negative effect 3.
• Studies have also compared the effects of BSS with other solutions, such as Ringer's lactate, on corneal thickness, endothelial morphology, and postoperative anterior chamber inflammation, and found that BSS offers a significant advantage over Ringer's lactate in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification 4, 5.
• Overall, the evidence suggests that room temperature BSS is safe for cataract surgery, and may have advantages over other solutions in terms of corneal health and postoperative inflammation 2, 4, 5.

Key Findings

• Room temperature BSS does not affect pupil diameter, corneal endothelium, and corneal pachymetry during and after phacoemulsification 2.
• Cooled irrigating eye solution may be beneficial in preventing the possible development of postoperative macular thickening, but room temperature BSS was not found to have a significant negative effect 3.
• BSS offers a significant advantage over Ringer's lactate in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification 4, 5.

Solution Comparison

• BSS versus Ringer's lactate: BSS offers a significant advantage over Ringer's lactate in terms of increase in corneal thickness and postoperative inflammation on the first postoperative day in patients undergoing phacoemulsification 4, 5.
• BSS versus modified Ringer's solution: The type of solution did not influence endothelial cell loss; however, the solution had a significant effect on corneal pachymetry 1 day postoperatively, with BSS Plus inducing less short-term corneal swelling than Ringer's solution 2.