1
|
Paauw J, Caplan MB, Gallardo M, Rushin K, Horn JD. Incidence of Postsurgical Intraocular Inflammation 6 Months After Implantation with a Multifocal Intraocular Lens. Clin Ophthalmol 2024; 18:1971-1980. [PMID: 39005584 PMCID: PMC11246081 DOI: 10.2147/opth.s458130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose This study assessed the incidence of postsurgical intraocular inflammation after cataract extraction by phacoemulsification and implantation with AcrySof IQ ReSTOR intraocular lenses (IOLs) produced using an updated manufacturing process. Incidence rates were compared with historical rates of postsurgical intraocular inflammation. Methods This was a prospective, multicenter, post-approval study at 34 sites. Patients aged ≥22 years received a study lens in at least 1 eye. Postsurgical intraocular inflammation (aqueous cell grade ≥3+ within 14 days after surgery, aqueous cell ≥2+ at 14 to ≤60 days after surgery, or aqueous cell ≥1+ at >60 days) was assessed within a 180-day period after implantation. Rates of toxic anterior segment syndrome (TASS), acute postoperative endophthalmitis, chronic postoperative endophthalmitis, and uncategorized cases of postsurgical intraocular inflammation were assessed. Ocular adverse events (AEs) and ocular adverse device effects (ADEs) were evaluated. Historical rates of postsurgical intraocular inflammation were determined from the 2011-2013 Medicare Limited Data Set files (a 5% sample of the Medicare data set representative of patients aged ≥65 years). Results Final safety analysis set included 3357 eyes (1792 patients; mean age, 68.6 ± 7.9 years). Postsurgical intraocular inflammation (any type) rate was 5.1 per 1000 attempted IOL implants (95% CI, 2.95, 8.10). TASS, acute postoperative endophthalmitis, and uncategorized inflammation rates were 0.6 (95% CI, 0.07, 2.15), 0.3 (95% CI, 0.01, 1.66), and 4.2 (95% CI, 2.28, 6.99) per 1000 attempted IOL implants, respectively. There were no events of chronic postoperative endophthalmitis. Ocular AEs and ADEs were reported in 17% and 1.5% of eyes, respectively. Most common ADEs were halo (0.63%) and glare (0.51%). The historical postsurgical inflammation rate from 221,519 cataract procedures was 10.3/1000 cataract surgeries, and the endophthalmitis rate was 1.2/1000 surgeries. Conclusion The updated IOL manufacturing process resulted in postoperative intraocular inflammation rates that were substantially lower than the historic rate.
Collapse
Affiliation(s)
- James Paauw
- Department of Ophthalmology, Piedmont Eye Center, Lynchburg, VA, USA
| | | | | | | | | |
Collapse
|
2
|
Kannan NB, Sivadarshan M, Sarkar AD, Vallinayagam M, Ramaswamy K. Outbreak of toxic anterior segment syndrome following vitreoretinal surgery - A retrospective analysis. Indian J Ophthalmol 2024; 72:860-863. [PMID: 38454870 PMCID: PMC11232845 DOI: 10.4103/ijo.ijo_1867_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/06/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Toxic anterior segment syndrome (TASS) is an uncommon complication of vitreoretinal surgery and is characterized by severe anterior chamber reaction, hypopyon, and limbus-to-limbus corneal edema. METHODS Twenty-nine vitreoretinal surgeries were performed, of which 14 developed TASS in the early postoperative period. The operative records were reviewed retrospectively. RESULTS The median age of patients was 49.07 ± 16.75 years and 14.28% of them were female. Also, 71.42% were operated in the left eye and 42.8% were pseudophakic. Recurrent retinal detachment, secondary scleral-fixating intraocular lens (SFIOL), and silicone oil removal (SOR) were the most common procedures. Severe anterior chamber reaction was seen in 14 patients, circumcorneal congestion in eight, corneal edema in 11 (78.6%), hypopyon in 13 (92.8%), and severe fibrin membrane in two patients. CONCLUSION We describe the largest series of TASS following uneventful vitreoretinal surgery. Balanced salt solution was the instigating agent in this series. A prompt and thorough investigation is critical in obviating recurrences.
Collapse
Affiliation(s)
- Naresh B Kannan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - M Sivadarshan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Avik Dey Sarkar
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - Kim Ramaswamy
- Chief Medical Officer, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| |
Collapse
|
3
|
Verma L, Malik A, Maharana PK, Dada T, Sharma N. Toxic anterior segment syndrome (TASS): A review and update. Indian J Ophthalmol 2024; 72:11-18. [PMID: 38131565 PMCID: PMC10841787 DOI: 10.4103/ijo.ijo_1796_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 12/23/2023] Open
Abstract
Toxic anterior segment syndrome (TASS) is an acute, sterile, postoperative inflammatory reaction of the anterior segment without vitreous involvement, following an uncomplicated and uneventful ocular surgery, having broad and multiple etiologies. The symptoms of decreased visual acuity and ocular discomfort generally occur within the first 12-48 h after intraocular surgery. The clinical signs include prominent limbus-to-limbus corneal edema, anterior chamber cells, aqueous flare, fibrinous inflammation, and/or keratic precipitates. There can be sight-threatening complications of TASS, such as permanent corneal decompensation, intractable glaucoma, and cystoid macular edema. The causes of TASS are emerging and being reported, so are the newer treatment options for managing the inflammation and its complications. Prevention guidelines for TASS are being updated, and a traceability system for surgical instruments and intraocular fluids used during the surgery is being perpetually developed. It is important to recognize TASS and start treatment on an immediate effect. Hereby, we review the literature on TASS, emphasizing its etiology, pathophysiology, management, prognosis, complications, and the importance of prevention as well as prompt recognition.
Collapse
Affiliation(s)
- Lalit Verma
- Consultant Ophthalmologist, Vitreoretinal Services, Centre for Sight, Safdarjung Enclave, New Delhi, India
| | - Anu Malik
- Cornea and Refractive Surgery Services, Dr. R. P. Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Prafulla K Maharana
- Cornea and Refractive Surgery Services, Dr. R. P. Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Tanuj Dada
- Cornea and Refractive Surgery Services, Dr. R. P. Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Namrata Sharma
- Cornea and Refractive Surgery Services, Dr. R. P. Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| |
Collapse
|
4
|
Ruiz-Lozano RE, Ramos-Davila EM, Garza-Garza LA, Gonzalez-Godinez S, Rodriguez-Garcia A. Challenges in the diagnosis and management of simultaneous, bilateral, toxic anterior segment syndrome after phacorefractive surgery. Digit J Ophthalmol 2023; 29:40-44. [PMID: 37727462 PMCID: PMC10506611 DOI: 10.5693/djo.02.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
A 59-year-old woman presented with a 24-hour history of severe, bilateral, painless vision loss starting 1 day after immediately sequential, bilateral, phacorefractive surgery with multifocal intraocular lens (IOL) implantation at another institution. Best-corrected visual acuity was counting fingers at 1 foot in the right eye and 20/100 in the left eye. Slit-lamp evaluation showed a dense fibrin membrane on the anterior surface of the IOL and significant anterior chamber inflammation in both eyes. B-scan ultrasound revealed bilateral vitreous haze, without membrane formation. The rapid onset, absence of sharp pain, ciliary injection, conjunctival chemosis, eyelid edema, and erythema raised suspicion for bilateral toxic anterior segment syndrome. Significant clinical improvement after high-dose prednisone and hourly prednisolone acetate eye drops supported the diagnosis. After 6 months of tapering anti-inflammatory therapy, optical coherence tomography of the macula showed no pathologic changes, and the patient's best-corrected visual acuity improved to 20/25 in both eyes.
Collapse
Affiliation(s)
- Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Eugenia M. Ramos-Davila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A. Garza-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Sara Gonzalez-Godinez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| |
Collapse
|
5
|
Li L, Zhou Q. Late-onset toxic anterior segment syndrome after ICL implantation: two case reports. BMC Ophthalmol 2023; 23:61. [PMID: 36774473 PMCID: PMC9921073 DOI: 10.1186/s12886-022-02713-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 11/26/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Toxic anterior segment syndrome (TASS) is a non-infectious inflammation that can occur after any anterior segment procedure. This case report presents two relatively rare late-onset TASS cases after V4c implantable collamer lens (ICL) operation. CASE PRESENTATION One 25-year-old woman and one 31-year-old woman suddenly had vision loss in monocular for 1 week after biocular V4c ICL operations and with no subjective complaints. They both presented fibrin formation in the anterior chamber such as keratic precipitates and white pus on the surface of the ICL. Fundus examination was normal. After 4 to 5 weeks of topical and oral steroid treatment, visual acuity and fibrin formation in the anterior chamber improved during the follow-up. CONCLUSIONS TASS should be suspected in any patient during the late period following ICL surgery; Once TASS is diagnosed, adequate treatment with intensive steroid therapy can be implemented.
Collapse
Affiliation(s)
- Li Li
- Refractive Surgery Center, Chongqing Eye and Vision Care Hospital, Yuzhong District, NO.77, the second Changjiang Road, Chongqing, China
| | - Qizhi Zhou
- Refractive Surgery Center, Chongqing Eye and Vision Care Hospital, Yuzhong District, NO.77, the second Changjiang Road, Chongqing, China.
| |
Collapse
|
6
|
Kaplan A, Tas MD, Selver OB. Unusual Inflammatory Clinical Presentation After Cataract Surgery and that Thought-provoking Question: Is this Infection or Toxic Anterior Segment Syndrome? Middle East Afr J Ophthalmol 2022; 29:196-199. [PMID: 38162566 PMCID: PMC10754112 DOI: 10.4103/meajo.meajo_126_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE Toxic anterior segment syndrome (TASS) is a noninfectious anterior chamber reaction caused by ocular surgeries. It usually develops within the first 12-48 h after surgery. In case of clinical suspicion of TASS, endophthalmitis as a devastating disease should always be excluded. However, the fact that TASS and endophthalmitis can look the same, but the treatment for each is different. Therefore, distinguishing between the two conditions is an important factor in coping with both diseases. It was aimed to describe the features and clinical management that are considered when distinguishing the cause of unexpected inflammatory response after cataract surgery. METHODS A retrospective review of medical records of 13 patients who developed TASS in our clinic at Ege University Ophthalmology Department on three different days between July 2022 and December 2022 were included in this study. Anterior segment photographs of those 13 patients and the records of ophthalmological examinations of those patients, including best-corrected visual acuity (BCVA), ocular pressure, biomicroscopic, and fundoscopic examination, were collected. Medical data were evaluated retrospectively. RESULTS The mean time to onset of clinical symptoms was 27.6 h. The main complaint was pain in nine patients. The primary symptom in the remainder of the patients was blurred vision. Severe hypopyon was seen in 5 cases. Despite the presence of pain and hypopyon, patients who were treated with topical steroids were closely followed up (every 2 h) because they were consecutive patients and had relatively acute onset complaints. Inflammation was regressed after an average of 4 h. No factor causing TASS was found. The BCVA was at the minimum level of 8/10 on the 5th day of surgery. CONCLUSION When distinguishing TASS from endophthalmitis, severe pain, relatively late onset, hyperemia, and the presence of severe hypopyon usually lead ophthalmologists to the clinical diagnosis of endophthalmitis. However, in this study, most of the patients diagnosed with TASS had severe pain, a significant portion of them had hypopyon, and the onset of the symptoms was relatively late. Close follow-up immediately after suspicion plays a vital role in clinical diagnosis and management accordingly.
Collapse
Affiliation(s)
- Anil Kaplan
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Muhammed D. Tas
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ozlem B. Selver
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| |
Collapse
|
7
|
Monnet D. Comment on: Late-onset toxic anterior segment syndrome after possible aluminum and silicon contaminated intraocular implantation. J Cataract Refract Surg 2022; 48:981-982. [PMID: 35916480 DOI: 10.1097/j.jcrs.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dominique Monnet
- From the Ophthalmology Department, Hôpital Cochin, APHP. Université Paris Cité, Paris, France
| |
Collapse
|
8
|
Reply to: Trace Element Quantification in IOLs, by Cesses C, et al. J Cataract Refract Surg 2022; 48:980-981. [DOI: 10.1097/j.jcrs.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Karatas Durusoy G, Gümüş G, Öcal MC, Kara N. Cases of toxic anterior segment syndrome after primary pterygium surgery. Int Ophthalmol 2022; 42:3229-3235. [PMID: 35567693 DOI: 10.1007/s10792-022-02325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. METHODS A case series. RESULTS Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. CONCLUSIONS This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.
Collapse
Affiliation(s)
| | - Gülşah Gümüş
- Ersin Aslan Training and Research Hospital, Gaziantep, Turkey
| | | | | |
Collapse
|
10
|
Matsushita K, Kawashima R, Hashida N, Hamano Y, Harada K, Higashisaka K, Baba K, Sato S, Huang W, Matsumoto H, Hamanaka T, Quantock AJ, Nishida K. Barium-induced toxic anterior segment syndrome. Eur J Ophthalmol 2021; 33:NP31-NP35. [PMID: 34967228 DOI: 10.1177/11206721211069223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Toxic anterior segment syndrome (TASS) is a rapid-onset inflammation of the eye following uneventful ocular surgery. We report a case of TASS following Baerveldt glaucoma implant (BGI) surgery. Inductively coupled plasma-mass spectrometry (ICP-MS) identified barium in the eye and in the eluate from the bleb of the BGI. We attribute TASS in our patient to the dissolution of barium from the BGI and its entry into the eye, where it causes severe inflammation.
Collapse
Affiliation(s)
- Kenji Matsushita
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Rumi Kawashima
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Yuki Hamano
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Kazuo Harada
- Department of Legal Medicine, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Kazuma Higashisaka
- Department of Legal Medicine, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Koichi Baba
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Weiran Huang
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Hiroshi Matsumoto
- Department of Legal Medicine, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
| | - Teruhiko Hamanaka
- Department of Ophthalmology, 26307Japanese Red Cross Medical Center, Tokyo, Japan
- Jyoetsu Ishida Eye Clinic, Niigata, Japan
| | - Andrew J Quantock
- School of Optometry and Vision Sciences, 2112Cardiff University, Cardiff, Wales, UK
| | - Kohji Nishida
- Department of Ophthalmology, Graduate School of Medicine, 38637Osaka University, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, 38637Osaka University, Osaka, Japan
| |
Collapse
|
11
|
Intraoperative and Postoperative Intraocular Lens Opacifications: Analysis of 42545 Cases. J Ophthalmol 2021; 2021:1285947. [PMID: 34912573 PMCID: PMC8668301 DOI: 10.1155/2021/1285947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/26/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the types and causes of intraocular lens (IOL) turbidity in a tertiary eye center. Setting. Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China. Design Retrospective case series. Methods Patients who underwent uncomplicated phacoemulsification and IOL implantation for cataract between January 2015 and December 2019 were included. Medical records were reviewed of participants with intraoperative or postoperative IOL opacification for clinical data, artificial crystal materials, and causes of the opacification. Results A total of 42545 IOLs were implanted in the five years, comprising 25471 (66.0%) hydrophilic IOLs, 11881 (27.9%) hydrophobic IOLs, and 2601 (6.1%) hydrophilic-hydrophobic acrylic IOLs. Among the operated eyes, 14 eyes (13 patients) experienced IOL opacification, which was permanent for 10 IOLs, including 7 (0.6%) hydrophilic IOLs (860UV) and 3 (0.2%) hydrophilic-hydrophobic acrylic IOLs (L-312). The mean interval between surgery and diagnosis of permanent opacification was 34.4 ± 18.4 (SD) months (range, 12 to 59 months). Permanent IOL clouding led to a statistically significant reduction in best corrected visual acuity (mean, 0.64 ± 0.4 logMAR; P < 0.004). Acute IOL clouding occurred in four eyes during the implantation of a hydrophilic-hydrophobic acrylic IOL of L-312, 809M, or 839M and returned to transparency several hours later. All four procedures were performed in winter, with the mean outside temperature being −5.75°C. Conclusions The rate of IOL opacification was 0.03%. Both delayed postoperative and acute intraoperative opacifications occurred with various characteristics in IOLs made of different materials and designs. Clinicians should be aware of this risk for cataract surgery.
Collapse
|
12
|
Late-onset Toxic Anterior Segment Syndrome after possible aluminum and silicon contaminated intraocular lens implantation. J Cataract Refract Surg 2021; 48:443-448. [PMID: 34417782 DOI: 10.1097/j.jcrs.0000000000000783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/07/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe an outbreak of late-onset toxic anterior segment syndrome (TASS) after the implantation of a specific hydrophilic acrylic intra-ocular lens (IOL). SETTING University Hospitals of Leuven, Belgium. DESIGN Retrospective, single-center, observational study. METHODS All eyes undergoing cataract surgery with a monofocal, toric or enhanced depth of focus (EDOF) Synthesis (Cutting Edge®) IOL between August 2019 and March 2020 were reviewed. Data were collected on the surgical procedure, postoperative course, time until onset of symptoms, clinical features, and additional treatments. A laboratory surface analysis of all three IOL subtypes was performed in the Intermountain Ocular Research Center at the University of Utah, USA. Furthermore, other possible causes of prolonged postoperative inflammation rather than the IOL itself were investigated. RESULTS Among the 203 eyes included, 28 TASS cases were identified (13.8%), among which 25 received a monofocal IOL, and 3 received an EDOF IOL. The mean time until onset was 28.9 (±19.9) days. Patients presented with anterior chamber cells (92.9%), deposits on the IOL (57.1%), or fibrinous inflammation (35.7%). Four eyes (14.3%) underwent a surgical intervention, whereas 24 eyes showed a resolution of inflammation with topical therapy alone. Laboratory analysis showed the presence of both aluminum and silicon particles on the monofocal IOL, silicon particles only on the EDOF IOL, and no particles on the toric IOL surface. CONCLUSION This report describes an outbreak of atypical, late-onset TASS after cataract surgery, possibly correlated to aluminum and silicon contamination of the IOL surfaces.
Collapse
|
13
|
Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model. Am J Ophthalmol 2021; 228:1-7. [PMID: 33826928 DOI: 10.1016/j.ajo.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To report a cluster of cases of toxic anterior-segment syndrome (TASS) in eyes implanted with a specific foldable acrylic intraocular lens (IOL) model. DESIGN Retrospective case series. METHODS The medical records were reviewed for 7 eyes of 4 patients diagnosed with TASS after cataract surgery at Shimane University and Matsue Red Cross Hospital between July and November 2020. RESULTS Among the 162 eyes implanted with the Lentis Comfort/LS-313 MF15 IOL, acute anterior chamber (AC) inflammation with fibrin formation developed 1-15 days after uneventful surgeries in 7 (4.3%) eyes (cataract surgery alone, n=4 eyes; combined cataract and minimally invasive glaucoma surgery, n=3 eyes). Other than local steroid use, fibrin membrane removal, YAG laser membranotomy, pars plana vitrectomy, and AC washout were performed to treat inflammation and/or secondary angle closure due to pupillary obstruction. CONCLUSION We experienced a cluster of TASS cases in eyes implanted with the Lentis Comfort/LS-313 MF15 IOL in a short period of time. To our knowledge, this is the first report of TASS associated with this IOL.
Collapse
|
14
|
Ksiaa I, Abroug N, Mahmoud A, Ben Amor H, Attia S, Khochtali S, Khairallah M. Hypopyon: Is-it Infective or Noninfective? Ocul Immunol Inflamm 2021; 29:817-829. [PMID: 34255602 DOI: 10.1080/09273948.2021.1922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases.
Collapse
Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Taher Sfar University Hospital of Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| |
Collapse
|
15
|
Sengillo JD, Chen Y, Perez Garcia D, Schwartz SG, Grzybowski A, Flynn HW. Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1548. [PMID: 33313293 PMCID: PMC7729369 DOI: 10.21037/atm-2019-rcs-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery. While several worldwide outbreaks of TASS have occurred, it is challenging to identify an etiology in order to reduce the risk of further cases. Endophthalmitis and TASS cannot be prevented completely, but their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence. This review highlights the current evidence in the prevention strategies for postoperative endophthalmitis and TASS.
Collapse
Affiliation(s)
- Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ying Chen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diley Perez Garcia
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
16
|
Shouchane-Blum K, Gershoni A, Mimouni M, Zahavi A, Segal O, Geffen N. The association between toxic anterior segment syndrome and intraocular pressure. Graefes Arch Clin Exp Ophthalmol 2020; 259:425-430. [DOI: 10.1007/s00417-020-04881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022] Open
|
17
|
Bantseev V, Miller PE, Nork TM, Rasmussen CA, McKenzie A, Christian BJ, Booler H, Thackaberry EA. Determination of a No Observable Effect Level for Endotoxin Following a Single Intravitreal Administration to Cynomolgus Monkeys. J Ocul Pharmacol Ther 2019; 35:245-253. [PMID: 30964386 DOI: 10.1089/jop.2018.0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To characterize the inflammatory response and determine the no-observable-effect level (NOEL) in cynomolgus monkey eyes after intravitreal (ITV) injection of endotoxin. Methods: The inflammatory response to endotoxin was assessed in a single-dose study in monkeys at doses of 0.01 to 0.51 endotoxin units (EU)/eye. Tolerability was assessed by clinical ophthalmic examinations, intraocular pressure measurements, fundus color photography, optical coherence tomography, and anatomic pathology. Results: ITV injection of endotoxin at ≥0.04 EU/eye resulted in a dose-related anterior segment inflammatory response. No aqueous flare or cell was noted in the 0.01 EU/eye dose group. A more delayed posterior segment response characterized by vitreous cell was observed beginning on day 5, peaking on day 15, and decreasing in some groups. Microscopic findings of mononuclear cell infiltrates in the vitreous were observed in eyes given ≥0.21 EU/eye. Conclusion: The NOEL for ITV endotoxin in cynomolgus monkeys was 0.01 EU/eye, suggesting that this species is as sensitive as rabbits to the effects of endotoxin. The vitreous cavity also appears more sensitive to endotoxin than the anterior segment/aqueous chamber. Overall, the magnitude of the inflammatory response at ≥0.04 EU/eye suggests that dose-response curve in monkeys is steeper than in rabbits. These data highlight the importance of assessing endotoxin level in ITV formulations, as levels as low as 0.04 EU/eye may confound the safety evaluations of ITV therapeutics in cynomolgus monkeys.
Collapse
Affiliation(s)
- Vladimir Bantseev
- 1 Genentech, Inc., Department of Safety Assessment, South San Francisco, California
| | - Paul E Miller
- 2 Department of Surgical Services, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin.,3 Ocular Services on Demand, LLC (OSOD), Madison, Wisconsin
| | - T Michael Nork
- 3 Ocular Services on Demand, LLC (OSOD), Madison, Wisconsin.,4 Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carol A Rasmussen
- 3 Ocular Services on Demand, LLC (OSOD), Madison, Wisconsin.,4 Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Aija McKenzie
- 1 Genentech, Inc., Department of Safety Assessment, South San Francisco, California
| | | | - Helen Booler
- 1 Genentech, Inc., Department of Safety Assessment, South San Francisco, California
| | - Evan A Thackaberry
- 1 Genentech, Inc., Department of Safety Assessment, South San Francisco, California
| |
Collapse
|
18
|
Hernandez-Bogantes E, Navas A, Naranjo A, Amescua G, Graue-Hernandez EO, Flynn HW, Ahmed I. Toxic anterior segment syndrome: A review. Surv Ophthalmol 2019; 64:463-476. [PMID: 30703402 DOI: 10.1016/j.survophthal.2019.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 01/29/2023]
Abstract
Toxic anterior segment syndrome is a surgical complication characterized by a noninfectious anterior chamber inflammatory reaction having multiple etiologies. The clinical signs (prominent limbus-to-limbus corneal edema, anterior chamber inflammation) and symptoms (decreased visual acuity, discomfort) generally occur within the first 12-48 hours after intraocular surgery. Most patients achieve good clinical and visual outcomes when there is a prompt clinical diagnosis and adequate treatment. We review the literature on toxic anterior segment syndrome, emphasizing its etiology, pathophysiology, and clinical and surgical management, as well as prognosis and sequelae. Our goal is to reduce the frequency of toxic anterior segment syndrome by highlighting the importance of prevention, early recognition, and distinguishing toxic anterior segment syndrome from infectious endophthalmitis.
Collapse
Affiliation(s)
- Erick Hernandez-Bogantes
- Centro Ocular, Heredia, Costa Rica; Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - Alejandro Navas
- Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - Andrea Naranjo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ike Ahmed
- Prism Eye Institute, University of Toronto, Ontario, Canada.
| |
Collapse
|
19
|
|
20
|
Park CY, Lee JK, Chuck RS. Toxic anterior segment syndrome-an updated review. BMC Ophthalmol 2018; 18:276. [PMID: 30359246 PMCID: PMC6203205 DOI: 10.1186/s12886-018-0939-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Toxic anterior segment syndrome (TASS) can be a rare complication of anterior segment surgery. Here we reviewed the most recent advances in the understanding of TASS. Methods English articles related to TASS were retrieved from “PubMed” using the following keywords; “toxic anterior segment syndrome” or “TASS”. The authors of this paper reviewed all the retrieved literature and critical findings were summarized. Results The onset of TASS can vary from hours to months. The clinical manifestations are also variable. The causes of TASS are broad and continue to expand and could not be elucidated in over half of the reported cases. Prompt and thorough investigation to explore the causes of TASS is critical. Surgeons should be fully aware and updated regarding possible etiologies and make ceaseless efforts to prevent TASS. This effort begins with establishing TASS prevention protocols and regularly training surgical staff. Proper cleaning of surgical instruments is critical and should follow the guidelines set by The American Society of Cataract and Refractive Surgery TASS Task Force. When TASS occurs, sharing information with other ophthalmologists and reporting new causes is crucial for the prevention of outbreaks. Conclusions Anterior segment surgeons should be reminded that TASS is mostly preventable by the establishment of TASS prevention protocols, regular surgical staff training and thorough adherence to recommendations for cleaning and sterilizing intraocular surgical instruments.
Collapse
Affiliation(s)
- Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, South Korea
| | - Jimmy K Lee
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
21
|
Inoue T, Uno T, Usui N, Kobayakawa S, Ichihara K, Ohashi Y. Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery. Jpn J Ophthalmol 2017; 62:24-30. [DOI: 10.1007/s10384-017-0545-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 09/26/2017] [Indexed: 11/25/2022]
|
22
|
Reversible opacification of hydrophobic acrylic intraocular lens- two cases report. BMC Ophthalmol 2017; 17:111. [PMID: 28666434 PMCID: PMC5493844 DOI: 10.1186/s12886-017-0509-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background The opacification of the intraocular lens (IOL) can cause significant visual deterioration. It is known that opacity of hydrophobic acrylic IOLs is rare. We report 2 cases of reversible optic opacification of hydrophobic acrylic intraocular lenses (Tecnis ZCB00, Abbott), observed within 2 months after uneventful cataract surgery. Case presentation Case 1: Uneventful cataract surgery was performed on the left eye of an 86-year-old diabetic man with chronic open-angle glaucoma. A hydrophobic acrylic intraocular lens (IOL; Tecnis ZCB00, Abbott, Lake Bluff, IL) was implanted in the bag. Eye drops containing 0.5% levofloxacin and 1.0% prednisolone were used after surgery along with topical anti-glaucoma medications. At 7 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by decreased visual acuity and increased intraocular pressure. However, the opacification completely disappeared after 9 weeks. Case 2: Uneventful cataract surgery was performed on the left eye of a 72-year-old woman. A hydrophobic acrylic IOL (Tecnis ZCB00) was implanted in the bag. At 2 weeks postoperative, cloudy, concentric IOL opacification developed, accompanied by ocular discomfort. After 4 weeks, opacification and discomfort completely disappeared. Conclusions We observed two cases of completely reversible opacification of hydrophobic acrylic IOLs. The exact nature of the transient opacity remains unclear, but an inflammatory origin cannot be completely ruled out.
Collapse
|
23
|
Oshika T, Eguchi S, Goto H, Ohashi Y. Outbreak of Subacute-Onset Toxic Anterior Segment Syndrome Associated with Single-Piece Acrylic Intraocular Lenses. Ophthalmology 2017; 124:519-523. [DOI: 10.1016/j.ophtha.2016.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022] Open
|
24
|
|
25
|
Lee MH, Cugley D, Atik A, Ang GS. Endophthalmitis or toxic anterior segment syndrome? Clin Exp Optom 2016; 100:94-95. [PMID: 27515565 DOI: 10.1111/cxo.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/13/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Matthew Hao Lee
- Ophthalmology Department, Alfred Health, Melbourne, Victoria, Australia
| | - Dean Cugley
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Alp Atik
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Ghee Soon Ang
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Suzuki T, Ohashi Y, Oshika T, Goto H, Hirakata A, Fukushita K, Miyata K. Reply: To PMID 25637181. Am J Ophthalmol 2015; 160:209. [PMID: 26054476 DOI: 10.1016/j.ajo.2015.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 11/20/2022]
|
27
|
Gonul S, Ozturk BT. Outbreak of Late-Onset Toxic Anterior Segment Syndrome After Implantation of One-Piece Intraocular Lenses. Am J Ophthalmol 2015; 160:208-9. [PMID: 26054475 DOI: 10.1016/j.ajo.2015.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
|