Transcript Folie 1

From Bach to Barry –
endophthalmitis now and then
Sibylle K. Scholtz, Gerd U. Auffarth
Johann Sebastian
Bach (1685 – 1750)16
International Vision Correction Research
Centre (IVCRC), Dept. of Ophthalmology,
University of Heidelberg, Germany
Peter Barry5
No financial interests
Introduction
Johann Sebastian Bach, considered to be
the most famous sacred musician of all time
died in 1750 eventually because of the
consequences of endophthalmitis due to
his unsuccessful cataract surgery6,10,11,12,13,14.
Still today the risk of endophthalmitis in
cataract
surgery
is
not
overcome
completely even having modern surgical
techniques
and
several
antibiotics
1,8
available .
This study showed that intracameral
cefuroxime administered at the time of
surgery significantly reduced the risk for
developing endophthalmitis after cataract
surgery1,5,7,8,15,17.
This poster wants to highlight the
achievements in modern ophthalmic
medicine that led to the ESCRS Guidelines
for endophthalmitis prophylaxis presented
by Peter Barry over the last two years1,8.
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Johann Sebastian Bach and his probably fatal cataract surgery
In August 1748, Bach’s hand writing began
to indicate that he had trouble with his eyes;
it is likely that he suffered from cataract.
There are no documents written by him after
1749, his wife or his son signed important
documents on his behalf.
At age 65, Bach decided to undergo
cataract surgery in late March of 1750 by
famous John Taylor. Taylor operated
exclusively on the left eye of his patients,
never mind which eye was worse affected
by the cataract2,6,9,10,11.
Johann Sebastian Bach
174616
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Johann Sebastian Bach and his probably fatal cataract surgery
The method of “couching” Taylor used was very painful and
dangerous: Proper anaesthesia (apart from alcohol and
opiates) was not available, nobody knew about the
importance of disinfecting eyes or surgical tools.
Johann Sebastian Bach´s eyes,
detail from the Haussmann
painting16
Taylor prepared his patients for surgery with laxatives,
bloodletting and eye drops made from pig’s blood, sugar
and salt. Moreover, the surgery was not performed at a
hospital, but on an “outpatient” basis (e.g. at inns)2,3,4,6.
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Johann Sebastian Bach and his probably fatal cataract surgery
Bach had his first eye surgery between March
28 and 31, 1750. Shortly after the operation,
the local newspaper published an article
reporting that Bach’s vision had improved,
which is not a very believable source, since
Taylor often issued publications of such reports
to advertise his business. Meanwhile, Taylor
had moved on to treat other people’s
cataract2,3,4,6,10.
Bach 1750 and his
signature16
When he came back to Leipzig, he performed another operation on Bach,
between April 5 and 7, 1750.
It is said that Bach went completely blind after the second surgery2,3,6.
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Johann Sebastian Bach and his probably fatal cataract surgery
We will never find out what exactly happened
to him. If Bach was completely blind after the
second surgery (app. 5. – 7. April 1750), and if
Taylor had again just treated one eye, the
cataract in the other eye must have been very
advanced, so that the eye was blind or had
extremely limited vision. Reports also indicate
that Bach was suffering from severe pain in his
eyes, which may have been caused by
increasing ocular pressure or by a deteriorating
eye infection2,3,4,6.
An eye infection could have caused blood
poisoning, which would have been life
threatening. Sources reporting that Bach had a
high fever support this view2,3,4,6.
Bach´s bust19
After weeks of suffering, Bach died on July 28,
1750, in Leipzig10. Taylor had long departed
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The ESCRS endophthalmitis study
The ESCRS study1,8 aimed to answer two
questions:
•Do perioperative antibiotics prevent
endophthalmitis?
•Should antibiotics be administered
intracamerally, topically, or both?
The study’s objectives were the
efficacy of the use of intracameral
cefuroxime and intensive perioperative
antibiotics versus placebo.
Preoperative antibiotic drops were not
used in the conventional sense7.
ESCRS endophthalmitis study, study groups[1]
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The ESCRS endophthalmitis study
Of 15,971 patients enrolled from 23 clinics across nine European countries, half
received 1mg of intracameral cefuroxime in 0.1ml of normal saline solution. All
patients received povidone-iodine preoperatively and also were randomized to
receive either topical levofloxacin or placebo drops7,17.
Postoperatively, all patients received topical levofloxacin drops four times a day for 6
days starting on postoperative day one7,17.
Results of analysis of
total endophthalmitis
cases1
The ESCRS study reasonably and accurately defined the true ratio of endophthalmitis
and unequivocally demonstrated the effect of cefuroxime. If cefuroxime was
commercially available in a single, sterile, ophthalmic unit dose, it would become the
gold standard of endophthalmitis prevention7.
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The ESCRS endophthalmitis study
Potential risk factors for endophthalmitis identified by the study included
the use of a silicone IOL and clear corneal incisions1,5,7,8,15,17.
Significant risk factors for
presumed
endophthalmitis[7]
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Conclusions
The celebrated British eye surgeon John Taylor
performed surgery on Bach twice visiting Leipzig in
March/April 1750. Bach died July 28th 1750, aged
65. Contemporary newspapers reported on
Bach’s death as "from the unhappy consequences of the very unsuccessful eye operation“2,3,4,6.
Today’s view is that Bach died finally because of
endophthalmitis. At that time a successful
cataract surgeon achieved about 80 - 90%
surviving eyes4,6. We do not know the exact
number of endophthalmitis cases at that time,
however, over the last two centuries it dropped
down to below 0.1 to 0.01%. Barry’s ESCRS study
results represent today’s best proven ways of
prophylaxis1,8,18.
Bach statue in Leipzig (D)16
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Results
At Bach´s time cataract surgery was
a very dangerous treatment due to
infections because of a bad
hygienic situation then.
This is today not the fact anymore.
There are antibiotics available as
well as modern surgical techniques.
Peter Barry’s ESCRS study results
provide a fundamental understanding of endophthalmitis today.
Peter Barry giving Ridley Medal Lecture15
References: [1]Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie C for the ESCRS Endophthalmitis Study Group, ESCRS study of prophylaxis of postoperative endophthalmitis after cataract
surgery, Preliminary report of principal results from a European multicenter study, J Cataract Refract Surg 2006; 32:407–410, [2] Zegers, R.A., The Eyes of Johann Sebastian Bach, Arch Ophthalmol,
Vol. 123, Oct. 2005, [3] Kubba, A.K., Young, M., Johann Sebastian Bach´s disastrous operation, IJCP, July/August 1997, [4] Glaukom-aktuell, Sekundärglaukom, Endophthalmitis, Sepsis – das lange
Sterben des Johann Sebastian Bach, Glaukom-aktuell, 1/2006, [5] Barry, P., ESCRS study on antibiotic prophylaxis of endophthalmitis yields positive result, Editorial, EuroTimes 03/2006, [6] Scholtz, S.,
Augenblick, Saarbrücken 2007, [7] Barry, P., Endophthalmitis: Recommendations Based on the ESCRS Study, J Cataract Refract Surg Today, 04/2007, 63 – 65, [8] Seal D, Barry P, Gettinby G, et al.
ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: case for a European multicentre study. J Cataract Refract Surg 2006;32:396-406, [9] Toellner, R., Illustrierte
Geschichte der Medizin, Vaduz 1992, [10] Korff, M., Johann Sebastian Bach, München 2000, [11] Geck, M., Bach. Leben und Werk, Reinbek 2001, [12] Wolff, C., Johann Sebastian Bach, Frankfurt
2005, [13] www.bach.de, [14] http://www.npj.com/thefaceofbach/index.html, [15] Barry P, Endophthalmitis following cataract surgery is preventable, EuroTimes 03/2006, [16]
http://de.wikipedia.org/wiki/Johann_Sebastian_Bach, [17] Barry P, Lessons From the ESCRS Study on Endophthalmitis Prophylaxis, Cataract & Refractive Surgery Today Europe, 9/2008, 54 – 56, [18]
Leitlinie zur Prophylaxe und Therapie von Endophthalmitiden, Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation und refraktive Chirurgie (DGII), August 2005, [19]
http://www.lastfm.de/music/Johann+Sebastian+Bach/+images/40791525.
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