Toxic anterior segment syndrome: A review

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 posi tive 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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Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime.

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.

Toxic Anterior Segment Syndrome Outbreak after Cataract Surgery Triggered by Viscoelastic Substance.

Purpose To evaluate the cytotoxicity of reusable cannulas for ophthalmic surgery after the cannulas were filled with an ophthalmic viscosurgical device (OVD) and cleaned with an enzymatic detergent. Setting Microbiological Testing Laboratory, Department of Medical-Surgical Nursing, University of Sao Paulo School of Nursing, and Cell Culture Section, Adolfo Lutz Institute, Sao Paulo, Brazil. Design Experimental study. Methods The sample consisted of 30 reusable 25-gauge injection cannulas, 20.0 mm in length, whose lumens were filled with an OVD solution for 50 minutes. The following steps were used to process the cannulas: (1) presoaking, (2) washing the lumen using a high-pressure water jet, (3) backwashing with enzymatic detergent in ultrasonic cleaner, (4) preliminary rinsing with tap water, (5) final rinsing with sterile distilled water, (6) drying with compressed filtered air, (7) wrapping in surgical-grade paper, and (8) steam sterilization at 134°C for 4 minutes. The cannulas were then tested for cytotoxicity according to the United States Pharmacopeia 32. Results The cleaning protocol used in this study removed residues of OVD solution and enzymatic detergent as shown by the lack of cytotoxicity of all sample extracts. Conclusion This cleaning protocol has the potential to minimize the occurrence of toxic anterior segment syndrome associated with residues of OVD solutions and enzymatic detergents. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosurgical device material.

PURPOSE To report a diffuse lamellar keratitis (DLK) cluster attributed to autoclave reservoir biofilm and to review the risk and prevention of DLK and toxic anterior segment syndrome (TASS) caused by such biofilms. SETTING Refractive Surgery Center, University of California, Berkeley. DESIGN Observational case-control study and review of literature. METHODS Eyes were evaluated for DLK following laser in situ keratomileusis (LASIK) over a 5-year period. Multiple changes in surgical and operating room protocols were prompted by a cluster of DLK cases. The autoclave reservoir chamber wall was cultured for microbial contamination. The MEDLINE database was used to identify relevant past publications. RESULTS From January 7, 2010, to December 18, 2014, 1115 eyes received LASIK. Between September 2, 2010, and June 11, 2012, 147 eyes of 395 LASIK cases developed DLK (37.2%). Systematic modifications in surgical protocols were unsuccessful in ending the prolonged cluster of DLK cases until the STATIM 2000 autoclave was replaced with a new STATIM autoclave and a reservoir sterilization and surveillance protocol implemented. Over the subsequent 30 months, DLK incidence was reduced to 2.2% (14 DLK cases from 632 total LASIK cases, P < .0001). The retired autoclave reservoir chamber wall cultures grew Pseudomonas aeruginosa and the Burkholderia cepacia complex. CONCLUSIONS Fluid reservoirs of tabletop steam autoclaves can readily develop polymicrobial biofilms harboring microbial pathogens, whose inert molecular byproducts can cause DLK and TASS when introduced to the eye by surgical instruments. Stringent reservoir cleaning and maintenance may significantly reduce this risk by preventing and removing these biofilms.

Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review.

Toxic anterior segment syndrome (TASS): studying an outbreak

http://www.aulamedica.es/gdcr/index.php/fh/article/download/785/785

L. Jiménez Lasanta

Papers

Toxic anterior segment syndrome (TASS): studying an outbreak

Síndrome tóxico del segmento anterior: investigación de un brote