Korean J Ophthalmol.  2008 Dec;22(4):220-227. 10.3341/kjo.2008.22.4.220.

Development of Toxic Anterior Segment Syndrome Immediately after Uneventful Phaco Surgery

• Choi JS
• Shyn KH

• KMID: 1084208
• DOI: http://doi.org/10.3341/kjo.2008.22.4.220

Abstract

PURPOSE: We report on 15 cases of suspected toxic anterior segment syndrome after uneventful phaco surgery. METHODS: We retrospectively reviewed the charts of patients who had developed toxic anterior segment syndrome (TASS) after uneventful phacoemulsification for senile cataracts between April and December of 2005. Clinical features and all possible causes were investigated including irrigating solutions or drugs, surgical instruments or intraocular lenses, sterilization techniques for instruments, or any other accompanying disease. RESULTS: The patients consisted of 2 males and 13 females with an average age of 64.7+/-10.9 years. Five different surgeons had performed their phaco surgeries. No abnormal preoperative or operative findings were reported. Nevertheless, all 15 patients developed a moderate degree of corneal edema. Ordinary treatments were not helpful. We suspect that lack of sterilization resulted in the development of the syndrome, because after ethylene oxide gas sterilization was replaced with autoclaving, no such incidents have occurred. CONCLUSIONS: Toxic anterior segment syndrome requires special attention and thorough management, including sterilization of reused surgical instruments.

Keyword

Corneal edema; Phacoemulsification; Toxic anterior segment syndrome

MeSH Terms

Aged
Aged, 80 and over
Anterior Eye Segment/*pathology
Corneal Edema/*etiology/pathology/surgery
Endophthalmitis/*etiology/pathology/surgery
Endotoxins/adverse effects
Female
Humans
Keratoplasty, Penetrating
*Lens Implantation, Intraocular
Male
Middle Aged
*Phacoemulsification
*Postoperative Complications
Retrospective Studies
Syndrome

Figure

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  Fig. 1 A, B, Postoperative corneal edema was evident in patient 10 (A) and 13 (B). Note the marked limbus to limbus edema and an irregular, unreactive pupil.

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  Fig. 2 A, B, Hematoxylin and eosin-stained sections of the corneal button obtained at the time of penetrating keratoplasty. The lack of endothelial cells was noted in (A) (patient 10) and subendothelial fibrosis was noted in (B) (patient 13). ×100.

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  Fig. 3 A, B, Hematoxylin and eosin-stained sections of the magnified anterior portion of the corneal button obtained at the time of penetrating keratoplasty in patient 10 (A) and 13 (B). Both show epithelial cysts and irregular epithelial cell proliferation consistent with bullous keratopathy. ×400.

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