Toxic Anterior Segment Syndrome Following Cataract Surgery

Kyu Yeon Hwang; Ji Wook Yang; Young Chun Lee; Su Young Kim

doi:10.3341/jkos.2011.52.6.690

Journal List > J Korean Ophthalmol Soc > v.52(6) > 1009057

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Hwang, Yang, Lee, and Kim: Toxic Anterior Segment Syndrome Following Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2011;52(6):690-695.

Published online: 31 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.6.690

Toxic Anterior Segment Syndrome Following Cataract Surgery

Kyu Yeon Hwang, MD, Ji Wook Yang, MD, Young Chun Lee, MD, PhD, Su Young Kim, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Su Young Kim, MD, PhD, Department of Ophthalmology, Uijeongbu St. Mary's Hospital #65-1 Geumo-dong, Uijeongbu 480-717, Korea Tel: 82-31-820-3110, Fax: 82-31-847-3418, E-mail: cassiopeia-su@hanmail.net

Received 1 September 2010 Revised 18 October 2010 Accepted 12 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report clinical and laboratory findings of toxic anterior segment syndrome (TASS) in seven patients following cataract surgery with intraocular lens (IOL) implantation.

Methods

The medical records of seven patients who underwent cataract surgery associated with postoperative decreased visual acuity, ocular pain, anterior chamber inflammation and corneal edema between Feb 2007 and Nov 2009 were retrospectively reviewed.

Results

All patients were over 60 years of age, four patients had diabetes and four patients had cardiovascular disease. Five patients had received hydrophilic IOL, and six patients underwent surgery later in order. All seven patients presented with increased anterior segment inflammation, acute decreased visual acuity, and severe corneal edema an average of 10.4 days (range 1 to 15 days) after surgery. Treatment of the seven patients included intensive topical and oral steroids, and improvement was noted in all patients.

Conclusions

The incidence of TASS after cataract surgery was 0.8%, and was significantly higher in cases of hydrophilic IOL insertion (5 of 284 cases, 1.76%) compared to cases of hydrophobic IOL insertion (2 of 581 cases, 0.34%) (p = 0.04). Five of the seven cases presented with TASS at postoperative day 14. Inflammation improved in all patients with steroid treatment.

Keywords: Cataract surgery, Endophthalmitis, Hydrophilic IOL, Steroid, Toxic anterior segment syndrome

References

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Figure 1.

Photograph, 14 days after cataract surgery of case 1. Diffuse corneal edema, severe anterior chamber inflammation (A), and severe anterior capsule contracture (B) are observed.

Figure 2.

Photograph, 1 day after cataract surgery of case 6. Diffuse corneal edema, severe anterior chamber inflammation, membranous deposit on the lens surface and hypopyons are observed.

Table 1.

Summary of the patients and outcomes

Case	Age/ Sex	Underlying disease	Original surgery	IOL^* manufacturer	Anesthesia	Clinial presentation	Diagnostics/ Intervensions	Final outcomes	Preoperative ECC^†	Postoperative ECC	ECC loss rate (%)
1	73/ Female	Diabetes	Phaco/IOL OS^‡	Hydrophilic one piece IOL	Retrobulbar block	POD^§ 14 Mild pain; VA^Π 20/1000; mod edematous cornea; ant. Capsular contracture; 3+ cell	Topical & systemic steroids, cycloplegics	POD 44 VA 20/100 Postop day 169 VA 20/25	2237	1748(POD 20 mon)	22%
2	67/ Male	Diabetes Hypertension Cerebrovascular accident(+)	r Phaco/IOL OS	Hydrophobic one piece IOL	Retrobulbar block	POD 15 Pain; VA 20/1000; mod edematous cornea	Topical & systemic steroids	POD 68 VA 20/40 normal exam	2538	2070(POD 18 mon)	18%
3	83/ Male	Hypertension	Phaco/IOL OD^#	Hydrophilic one piece IOL	Retrobulbar block	POD 14. VA 20/60 mild edematous cornea; 3+ cell;	Topical steroids	POD 112 VA 20/32 normal exam	2551	NM^**	−
4	79/ Female	Diabetes	Phaco/IOL OD	Hydrophilic one piece IOL	Retrobulbar block	POD 14 Pain; VA 20/125; mod edematous cornea; Keratic precipitate; 3+ cell; membrane	Topical & systemic steroids, Hypertonic saline	POD 108 VA 20/32 normal exam	2695	2564(POD 36 mon)	5%
5	79/ Female	Diabetes	Phaco/IOL OS	Hydrophilic one piece IOL	Retrobulbar block	POD 14 Pain; VA 20/125; mod edematous cornea; 3+ cell; membrane	Topical & systemic steroids, Hypertonic saline	POD 185 VA 20/22 normal exam	2375	NM	−
6	68/ Male	Hypertension	Phaco/IOL OD	Hydrophilic one piece IOL	Topical	POD 1 pain; VA 20/1000; mod edematous cornea; 3+ cell; 2+ flare; hypopyon	Topical & systemic steroids, cycloplegics Subconj. dexamethasone injection	POD 35 VA 20/40 normal exam Culture(−),	2288	2277(POD 36 mon)	0.5%
7	65/ Female	Arrhythmia	Phaco/IOL OS t	Hydrophobic three piece IOL	Topical	POD 1 VA 20/40; mild edematous cornea; + cell; thick membrane	Topical steroids	POD 41 VA 20/30;- cell	2304	NM	−

^* IOL = intraocular lens

^† ECC = endothelial cell counts (cells/mm²)

^‡ OS: left eye

^§ POD = post operative day

^Π VA = visual acuity

^# OD: right eye

^** NM = not measured.

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