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To the Editor.
—At our affiliate Veterans Administration Hospital, we have observed a series of patients with apparent intraoperative endothelial edema that we believe is associated with variations in pH and osmolarity of the balanced salt solution (BSS). In retrospect, these problems began shortly after the hospital pharmacy switched suppliers of BSS without our consultation, evidently for economic reasons. The endothelial edema was variable from case to case, with some cases demonstrating little to no edema, while several cases exhibited sufficient edema to create difficulty with cortical aspiration. After eliminating several possible causes, we noted a clear temporal relationship between our use of Pharmafair (Hauppauge, NJ) BSS (lot Nos. 4017 and 4207) and the observed edema. Once this association was realized, we discontinued the use of Pharmafair BSS and analyzed the remaining 300-mL sealed glass bottles of BSS in our own research laboratory and in our clinical laboratories at the
Briggs RB, McCartney DL. Balanced Salt Solution Infnusion Alert. Arch Ophthalmol. 1988;106(6):718. doi:10.1001/archopht.1988.01060130788003