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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.
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Affiliation(s)
| | - Gülşah Gümüş
- Ersin Aslan Training and Research Hospital, Gaziantep, Turkey
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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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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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Grzybowski A, Brockmann T, Kanclerz P, Pleyer U. Dexamethasone Intraocular Suspension: A Long-Acting Therapeutic for Treating Inflammation Associated with Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:525-534. [DOI: 10.1089/jop.2019.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrzej Grzybowski
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Tobias Brockmann
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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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.
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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.
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Min CH, Kwon J. Pseudophakic Pupillary Block after Toxic Anterior Segment Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.8.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chan Hong Min
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junki Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Grzybowski A, Kanclerz P. Do we need day-1 postoperative follow-up after cataract surgery? Graefes Arch Clin Exp Ophthalmol 2018; 257:855-861. [DOI: 10.1007/s00417-018-04210-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022] Open
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Kasım B, Koçluk Y, Burcu A. Interface fluid syndrome secondary to endothelial failure due to toxic anterior segment syndrome after cataract surgery. Eur J Ophthalmol 2018; 29:NP1-NP4. [DOI: 10.1177/1120672118800241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To present a case of previous laser in situ keratomileusis with interface fluid syndrome secondary to toxic anterior segment syndrome following cataract surgery. Case report: A 52-year-old woman, complaining blurred vision in her right eye for 18 months after cataract surgery, was referred to our clinic. She was diagnosed with toxic anterior segment syndrome, postoperatively, which resolved in 3 days. She had a history of laser in situ keratomileusis surgery 15 years ago. Slit-lamp examination of the right eye showed corneal haze, limited to laser in situ keratomileusis flap. The patient was diagnosed with interface fluid syndrome secondary to endothelial decompensation due to toxic anterior segment syndrome. Descemet’s membrane endothelial keratoplasy was performed along with full thickness fenestrations in the laser in situ keratomileusis flap to the right eye of the patient. The fluid was resolved in 1 week and visual acuity was improved rapidly. Conclusion: This case shows the importance of considering the diagnosis and determining the specific etiology of interface fluid syndrome, even years after the laser in situ keratomileusis surgery, when endothelial cell function has been compromised with any factor, such as intraocular surgery and its complications.
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Affiliation(s)
- Burcu Kasım
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Yusuf Koçluk
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayşe Burcu
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey
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Affiliation(s)
- N. Demet Ozcelik
- Department of Ophthalmology, Istanbul Education and Research Hospital, Istanbul - Turkey
| | | | - Burak Bilgin
- Almangoz Eye Center, Nisantasi, Istanbul - Turkey
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Sharma N, Singhal D, Nair SP, Sahay P, Sreeshankar SS, Maharana PK. Corneal edema after phacoemulsification. Indian J Ophthalmol 2017; 65:1381-1389. [PMID: 29208818 PMCID: PMC5742966 DOI: 10.4103/ijo.ijo_871_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through phacoemulsification, most of the patients are able to achieve excellent visual outcome. Corneal edema after phacoemulsification in the immediate postoperative period often leads to patient dissatisfaction and worsening of outcome. Delayed onset corneal edema often warrants endothelial keratoplasty. This review highlights the etiopathogenesis, risk factors, and management of corneal edema in the acute phase including descemet's membrane detachment (DMD) and toxic anterior segment syndrome. Various investigative modalities such as pachymetry, specular microscopy, anterior segment optical coherence tomography, and confocal microscopy have been discussed briefly.
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Affiliation(s)
- Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Singhal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sreelakshmi P Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S S Sreeshankar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Altıntaş AK, Ciritoğlu MY, BeyazyıldıZ Ö, Can ÇÜ, Polat S. Toxic Anterior Segment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance. Middle East Afr J Ophthalmol 2017; 24:43-47. [PMID: 28546691 PMCID: PMC5433127 DOI: 10.4103/meajo.meajo_226_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The purpose of this study is to present toxic anterior segment syndrome (TASS) outbreak at our clinic and discuss possible causes of TASS. MATERIALS AND METHODS: Thirty-four eyes of 34 patients developed TASS in a consecutive 2 weeks period were included in this study. Both anterior segment and fundus examinations were performed before and after uncomplicated cataract surgery. During the follow-up period, clinical features and all possible causes were evaluated including perioperative products and processing such as sterilization technique of surgical instruments, irrigating solutions, drugs, viscoelastic substance (VES), and intraocular lens. RESULTS: Patients had corneal edema, anterior chamber reactions, and decreased vision. No patient had purulent secretion, chemosis, lid involvement, and pain. At first 2 postoperative days, patients treated as infectious endophthalmitis by topical and oral antibiotics and then TASS was suspected, and patients treated completely with topical steroids. Suspected cause for TASS was VES substance, 2% sodium hyaluronate which had newly been used as VES product in phacoemulsification surgery. No new case has occurred after stopped usage of this VES product. CONCLUSION: As far as we know, this is the largest report of TASS outbreak in the shortest period from the same clinic caused by VES. Suboptimal products of surgical materials can be the cause of TASS. Close monitoring of each surgical step and elimination of causative agent can prevent the outbreaks of TASS.
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Affiliation(s)
- AyşeGül Koçak Altıntaş
- Department of Ophthalmology, Ulucanlar Eye Research and Training Hospital, Ankara, Turkey
| | | | - Özlem BeyazyıldıZ
- Department of Ophthalmology, Samsun Research and Training Hospital, Samsun, Turkey
| | - Çiğdem Ülkü Can
- Department of Ophthalmology, Ulucanlar Eye Research and Training Hospital, Ankara, Turkey
| | - Sibel Polat
- Department of Ophthalmology, Ulucanlar Eye Research and Training Hospital, Ankara, Turkey
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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
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Kaur M, Titiyal JS, Falera R, Arora T, Sharma N. Outcomes of Descemet Stripping Automated Endothelial Keratoplasty in Toxic Anterior Segment Syndrome After Phacoemulsification. Cornea 2017; 36:17-20. [DOI: 10.1097/ico.0000000000001067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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
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Cowperthwaite L, Holm RL. Guideline Implementation: Surgical Instrument Cleaning. AORN J 2015; 101:542-9; quiz 550-2. [DOI: 10.1016/j.aorn.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Evaluation of the retinal, choroidal, and nerve fiber layer thickness changes in patients with toxic anterior segment syndrome. Graefes Arch Clin Exp Ophthalmol 2014; 253:467-75. [PMID: 25467759 PMCID: PMC4345267 DOI: 10.1007/s00417-014-2880-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/04/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate changes in choroidal, retinal, and nerve fiber layer (NFL) thickness following toxic anterior segment syndrome (TASS). Methods Macular and peripapillary choroidal thickness was measured using enhanced depth imaging (EDI) optical coherence tomography (OCT) on the day of the diagnosis and on three follow-up exams (months 1 to 4). A similar OCT analysis of central retinal and NFL thickness was performed. Results Thirteen TASS patients were included. Average age was 72.8 ± 8.7 years. Macular choroidal thickness in the superior, subfoveal, and nasal macula in the study eye was larger than the control eye and decreased at months 2–4. This was statistically significant only for the superior macula (p = 0.004). Peripapillary choroidal thickness was larger in the study eye at baseline compared with the control eye—significantly so in the nasal (p = 0.026) and inferior (p = 0.033) locations. Peripapillary choroidal thickness peaked at the baseline or 1st month exam and decreased thereafter. Retinal thickness increased significantly with time, peaking at the 2nd month and decreasing thereafter. No changes were found in the NFL. Conclusions TASS may have a transient effect on the choroid. Changes in retinal thickness are probably a normal transient postoperative response and not a result of TASS.
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Dotan A, Kaiserman I, Kremer I, Ehrlich R, Bahar I. Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome. Br J Ophthalmol 2013; 98:252-5. [DOI: 10.1136/bjophthalmol-2013-304294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ari Ş, Caca İ, Sahin A, Cingü AK. Toxic anterior segment syndrome subsequent to pediatric cataract surgery. Cutan Ocul Toxicol 2011; 31:53-7. [DOI: 10.3109/15569527.2011.613426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sengupta S, Chang DF, Gandhi R, Kenia H, Venkatesh R. Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital. J Cataract Refract Surg 2011; 37:1673-8. [DOI: 10.1016/j.jcrs.2011.03.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 11/25/2022]
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Park YH. Toxic anterior segment syndrome after uncomplicated cataract surgery. Eur J Ophthalmol 2010; 20:1089; author reply 1089-90. [PMID: 20954149 DOI: 10.1177/112067211002000614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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