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Abstract
Purpose
To report 3 unusual cases of toxic anterior segment syndrome resembling transparent amoeboid deposits following cataract surgery and to determine effective treatment methods.
Case summary
Three patients underwent uneventful phacoemulsification with implantation of a hydrophobic acrylic intraocular lens (IOL) and patching with antibiotic/steroid ointment at the end of surgery. At a mean of 15 days postoperatively, a significant number of anterior chamber inflammatory cells and multiple transparent amoeboid deposits with central, elevated, gray-white opaque material on the anterior surface of the IOL were observed. In two cases, greasy material coated the anterior surface of the IOL in a wavy pattern. All laboratory tests to exclude infectious endophthalmitis were negative. Presuming postoperative inflammation, intensive topical steroid was administered. After treatment, anterior chamber reactions decreased; however, the multiple whitish deposits remained. Subsequently, a Nd:YAG laser (0.8 mJ) was used to disrupt and remove the precipitates. The masses were easily and obviously removed by laser therapy, and the mild residual inflammation resolved satisfactorily with mild topical steroid treatment. No recurrence or related complications developed during the two-year follow-up period in any patients.
Conclusions
The delayed postoperative inflammation onset resembling amoeboid deposits is thought to be caused by ingress of ointment into the eye. The specific lumpy deposits cannot be controlled with topical steroids, although Nd:YAG laser treatment can effectively remove inflammatory cell deposits mingled with greasy oil material.
Figures and Tables
Figure 1
(A) In case 1, despite intensive topical steroid therapy, multiple, elevated, gray-white, opaque deposits appeared in a scattered pattern on the anterior surface of the lens 2 weeks postoperatively (left). Under retro-illumination, multiple transparent, amoeboid deposits with central, elevated, dense precipitates were definitively observed (middle). Multiple deposits were very easily disrupted and removed by Nd:YAG (0.8 mJ) laser, and there was no recurrence during a 2 year follow-up period (right). (B) Case 2 showed similar clinical features. (C) Case 3 showed a significant posterior capsular opacity with concurrent multiple amoeboid deposits (left). Greasy oil-like deposits were prominent under retro-illumination (middle). Posterior capsulotomy and disruption of precipitates on the anterior surface of the lens with Nd:YAG laser were performed. Multiple deposits were successfully removed (right).
Figure 2
Greasy oil films with a wavy pattern were seen coating the anterior optic surface of the intraocular lens in case 1 (A) and case 3 (B) at high magnification (×25).
Figure 3
(A, D) Before Nd:YAG laser therapy, the multiple transparent, amoeboid deposits with central, elevated, dense precipitates were distinctly observed. (B, E) Immediately after Nd:YAG laser (0.8 mJ) application, precipitates on the optic in case 1 were very easily removed by laser treatment and their remnants were dispersed into the anterior chamber. (C, F) Two weeks after laser treatment, there was no recurrence of deposits at the laser sites and the optic surface remained very clear. Also, the surrounding remnants were nearly completely absorbed.
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