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Ginger-Eke H, Ogbonnaya C, Odayappan A, Shiweobi J. Toxic anterior segment syndrome following trabeculectomy with mitomycin C. GMS OPHTHALMOLOGY CASES 2023; 13:Doc17. [PMID: 37850220 PMCID: PMC10577659 DOI: 10.3205/oc000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Objective Toxic anterior segment (TASS) is a rare acute sterile anterior segment inflammation that typically develops within 12 to 24 hours after an anterior segment surgery. The purpose of this case report is to alert surgeons to the possibility of this complication following any anterior segment surgery, including trabeculectomy, and to highlight the possible etiologies and measures to prevent it. Patient and method A 58-year-old male glaucoma patient was initially managed medically for primary open angle glaucoma with antiglaucoma medications. There was rapidly progressive glaucomatous optic nerve damage in his left eye within the following year, despite the use of antiglaucoma medications, hence the need for trabeculectomy. Result The post-operative condition of the patient's eye was stormy with diffuse limbus-to-limbus corneal edema and profound Descemet's membrane folds, among other features of TASS, with associated deteriorating visual acuity. Conclusion Although there is no documented report of TASS following trabeculectomy with mitomycin C, surgeons should be alerted to this possibility. Preventive measures include extreme care to avoid errors while preparing and administering diluted solutions, especially medications that are administered into the intracameral space.
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Affiliation(s)
- Helen Ginger-Eke
- Department of Ophthalmology, Ebonyi State University, Abakaliki, Nigeria
- Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Chimdia Ogbonnaya
- Department of Ophthalmology, Ebonyi State University, Abakaliki, Nigeria
- Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | | | - Jude Shiweobi
- Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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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.
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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
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Necip K, Oltulu R, Levent D, Osman GA. Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series. Cornea 2021; 40:1007-1010. [PMID: 33009092 DOI: 10.1097/ico.0000000000002524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS). METHODS Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively. RESULTS There were 8 men and 5 women, with an average age of 56 ± 19 years. The mean follow-up was 8.7 ± 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.±6.6 months (range, 1.5-26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 ± 69 μm) to postoperative last visit (523 ± 71 μm) was statistically significant (P < 0.001). CONCLUSIONS DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.
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Affiliation(s)
- Kara Necip
- Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, Turkey; and
| | - Refik Oltulu
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Dogan Levent
- Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, Turkey; and
| | - Gundogan Ali Osman
- Department of Ophthalmology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Unilateral Toxic Anterior Segment Syndrome Resulting in Cataract and Urrets-Zavalia Syndrome after Sequential Uneventful Implantation of a Posterior Chamber Phakic Toric Intraocular Lens at Two Different Surgical Facilities: A Series of Unfortunate Events. Case Rep Ophthalmol Med 2020; 2020:1216578. [PMID: 33204556 PMCID: PMC7657676 DOI: 10.1155/2020/1216578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Phakic Intraocular Lens (P-IOL) implantation is a safe, easy, predictable intervention designed to manage moderate to high refractive errors. Complications are relatively uncommon and include mainly cataract and intraocular pressure spikes. Toxic Anterior Segment Syndrome (TASS) is a rather unusual sterile anterior segment inflammation after uneventful intraocular surgery, extremely rarely reported after P-IOL implantation. Urrets-Zavalia Syndrome (UZS) is also very rarely described after P-IOL. To date, to the best of the authors' knowledge, no article has ever described the simultaneous occurrence of TASS and UZS in a patient after P-IOL implantation. Objective In this article, the authors present the case of a female patient with moderate myopic astigmatism, who underwent sequential P-IOL implantation at two different facilities. The postoperative course of the first eye was uneventful, but she developed complications associated to the intervention in the second eye. Materials The article describes the case of a young patient who underwent a sequential Phakic Intraocular Lens (P-IOL) implantation at two different institutions. The postoperative course of the first eye (left eye) was uneventful; however, the second eye (right eye) initially developed Toxic Anterior Segment Syndrome (TASS). Although timely and correct management was instituted, upon resolution of TASS, the patient developed Urrets-Zavalia Syndrome, anterior subcapsular cataract, and significant endothelial damage in the same eye. Results The patient was followed closely and managed accordingly; corneal edema and anterior segment inflammation of the right eye eventually resolved. Nevertheless, an anterior subcapsular cataract and a fixed dilated pupil remained; with normal intraocular pressure (IOP). Specular microscopy confirmed an endothelial cell loss in the TASS eye (right eye). Pupil size showed no reaction to repeated doses of Pilocarpine 2%. A month after surgery, refraction on her right eye was +0.25 + 0.75 × 93, which resulted in a 20/50 vision. Conclusions TASS and UZS are both extremely rare complications after uneventful P-IOL implantation, with only a handful of cases having been reported of each of them. To date, this is the very first case where UZS ensued after and potentially as a consequence of TASS in a patient who had undergone P-IOL implantation. Although a direct causative element could not be pinpointed, the fact that the complication ensued after being operated in one surgical institution and not the other, could suggest some role of different sterilization and handling procedures, but no direct conclusion can be made on this case.
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Dowler KK, Middleton JR, Dufour S, Hood MA, Giuliano EA. Characterization of postoperative "fibrin web" formation after canine cataract surgery. Vet Ophthalmol 2020; 24:37-47. [PMID: 32981182 DOI: 10.1111/vop.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe the occurrence and associated factors for "fibrin web" (FW) formation following phacoemulsification in dogs. METHODS A retrospective review of medical records of all dogs undergoing phacoemulsification (MU-Veterinary Health Center, 2014-2018) was conducted to associate FW formation with signalment, systemic co-morbidities, cataract stage, surgeon (resident vs faculty), phacoemulsification time, IOL, and intracameral injections including viscoelastic type. Both univariate and multivariate statistical analyses were performed to evaluate associations among variables with FW formation. RESULTS Data from 398 eyes on 201 dogs were included; 4 left eyes (4 dogs) developed presumptive endophthalmitis and were excluded from further analysis. Forty-eight eyes did not have cataract surgery. Hence, 350 eyes on 201 dogs were included in the analyses. Among these, 84 eyes (59 dogs) developed a FW. Univariate analyses showed that the odds of FW increased with age and phacoemulsification time. Additionally, FW web was associated lens type, lens brand, and viscoelastic type. Multivariate analyses showed that when comparing lens types in combination with a particular viscoelastic, viscoelastic impacted the estimated prevalence of FW formation the most. In contrast, when the data were analyzed by lens brand, lens brand impacted prevalence more than viscoelastic type. Diabetes mellitus was not associated with FW formation. CONCLUSIONS Based on the available data, intraocular lens implantation, viscoelastic type, dog age, and phacoemulsification time were associated with FW formation. Diabetes mellitus, gender, cataract stage, surgeon, intracameral injections other than viscoeleastic, and intra- and postoperative complications were not associated with FW formation.
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Affiliation(s)
- Kourtney K Dowler
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - John R Middleton
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Simon Dufour
- Department of Pathology and Microbiology, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Margaret A Hood
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Elizabeth A Giuliano
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
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Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review. J Cataract Refract Surg 2020; 46:340-349. [DOI: 10.1097/j.jcrs.0000000000000070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hernandez-Bogantes E, Ramirez-Miranda A, Olivo-Payne A, Abdala-Figuerola A, Navas A, Graue-Hernandez EO. Toxic anterior segment syndrome after implantation of phakic implantable collamer lens. Int J Ophthalmol 2019; 12:175-177. [PMID: 30662859 DOI: 10.18240/ijo.2019.01.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/25/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Erick Hernandez-Bogantes
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico.,Ocular Center, Heredia 40101, Costa Rica
| | - Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico
| | - Andrew Olivo-Payne
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico
| | - Alexandra Abdala-Figuerola
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico.,Department of Cornea and Refractive Surgery, Atlantic Laser Unit Center, Barranquilla 84-98, Colombia
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea and Refractive Surgery, Conde of Valenciana Foundation Institute of Ophthalmology, Mexico City 06800, Mexico
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Althomali TA. Viscoelastic substance in prefilled syringe as an etiology of Toxic Anterior Segment Syndrome. Cutan Ocul Toxicol 2015; 35:237-41. [DOI: 10.3109/15569527.2015.1082579] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Çakır B, Celik E, Aksoy NÖ, Bursalı Ö, Uçak T, Bozkurt E, Alagoz G. Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime. Clin Ophthalmol 2015; 9:493-7. [PMID: 25834384 PMCID: PMC4370909 DOI: 10.2147/opth.s74249] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime. Methods We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS. Results The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed. Conclusion All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.
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Affiliation(s)
- Burçin Çakır
- Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Erkan Celik
- Sakarya University Education and Research Hospital, Sakarya, Turkey
| | | | - Özlem Bursalı
- Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Turgay Uçak
- Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Erdinç Bozkurt
- Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Gursoy Alagoz
- Sakarya University Education and Research Hospital, Sakarya, Turkey
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Fulminant Panuveitis following Iris Suture Fixation of Posterior Chamber Intraocular Lens. Case Rep Ophthalmol Med 2013; 2013:910342. [PMID: 23476849 PMCID: PMC3583087 DOI: 10.1155/2013/910342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 11/17/2022] Open
Abstract
We present a case of fulminant panuveitis following iris suture fixation of a posterior chamber intraocular lens. We hypothesize that the zonular dehiscence allowed the inflammatory cells in the anterior compartment to gain access to the posterior segment mimicking endophthalmitis or toxic anterior segment syndrome. Also certain bulky lens designs, like the current Rayner hydrophilic acrylic lens, are difficult to manipulate and hold in the optic capture position, and hence the iris fixation of these lenses can be traumatic and lengthy. It is advised to exchange such lenses with 3-piece intraocular lenses that are easy to fixate.
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Nakatani Y, Nishimura A, Sugiyama K. Successful treatment of corneal wasp sting-induced panuveitis with vitrectomy. J Ophthalmic Inflamm Infect 2013; 3:18. [PMID: 23514564 PMCID: PMC3605111 DOI: 10.1186/1869-5760-3-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/12/2012] [Indexed: 11/22/2022] Open
Abstract
Background This study aims to present the management and clinical findings of a case of corneal wasp sting and to report the outcome of corneal change and panuveitis after vitrectomy. Findings Clinical findings, anterior segment photographs, corneal endothelial changes, and medical treatment of corneal wasp sting-induced panuveitis are presented. A 95-year-man was stung by a wasp on his left cornea. A severe conjunctival hyperemia, marked corneal edema, corneal epithelial defect, and uveitis developed. As soon as the patient visited our clinic, topical corticosteroid and antibiotics were given, but corneal endothelial damage and uveitis did not improve. Anterior chamber irrigation was performed with oxiglutatione solution to rinse out the wasp venom. Corneal edema and anterior uveitis improved but the endothelial cell density gradually decreased and the vitreous opacity deteriorated. Therefore, a 23-gauge vitrectomy was performed. Subsequently, the corneal edema and panuveitis improved. Conclusions Vitrectomy may be an effective treatment for corneal endothelial damage and endophthalmitis induced by a corneal wasp sting.
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Affiliation(s)
- Yusuke Nakatani
- Department of Ophthalmology and Visual Science, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan.
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