Pseudophakic Pupillary Block after Toxic Anterior Segment Syndrome

PURPOSE: We report a case of pseudophakic pupillary block after toxic anterior segment syndrome (TASS). CASE SUMMARY: An 84-year-old woman underwent phacoemulsification and intraocular lens implantation in the posterior chamber. Six days after surgery, anterior chamber inflammation was seen. Twenty-five days after surgery, a sudden increase in intraocular pressure (IOP) associated with pupillary block was observed. Despite the use of IOP-lowering medication, the IOP was not controlled. Peripheral laser iridotomy failed. After surgical peripheral iridectomy, IOP decreased significantly and was controlled. CONCLUSIONS: Despite the rarity of TASS combined with pseudophakic pupillary block, clinicians must be aware of this condition in patients showing prolonged inflammatory state and IOP elevation after surgery.

Research progress of toxic anterior segment syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#Toxic anterior segment syndrome(TASS)is a kind of acute and non-infective anterior segment inflammatory reaction. It's relatively rare for clinic, but recently, TASS is in increasing tendency with the development of anterior segment surgery. During surgery, various non-infective maters entering the anterior chamber all could result the appearance of TASS. After timely and effective treatment, most patients have favorable prognosis, however, a few patients may have remained permanent intraocular tissues damage to the extent of influencing eyesight. Now, this thesis summarizes the pathology, diagnosis, differential diagnosis, pathogenesis, prevention, treatment, prognosis etc. of TASS.

Toxic anterior segment syndrome.

In this era of topical cataract surgeries, where patients come and get operated within 15-20 minutes and walk with 20/20 vision from the hospital, there is a nightmare for ophthalmologists which is called endophthalmitis and Toxic Anterior Segment Syndrome(TASS). Despite an uneventful surgery patient may land in ophthalmologist’s outpatient department with decreased vision the next day because of TASS. Mild cases respond to treatment but severe cases may end up losing vision and may require further intraocular surgeries. Thus, steps should be taken to prevent this monstrous disease from happening. This article reviews how to diagnose, treat and prevent TASS.

Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery.

Toxic anterior segment syndrome (TASS) is an acute sterile postoperative anterior segment infl ammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.

Nd:YAG Photodisruption of Toxic Anterior Segment Syndrome Related to Amoeboic Deposits

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.

Toxic Anterior Segment Syndrome Following Cataract Surgery

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.

Iris en sayuela signo clínico nuevo asociado al síndrome tóxico del segmento anterior / Iris in underskirt: a new clinical sign associated to the anterior segment toxic syndrome

OBJETIVO: Presentar un nuevo signo clínico como resultado del desprendimiento gigante del epitelio pigmentado posterior del iris en el curso de un síndrome tóxico del segmento anterior tras una cirugía de catarata. MÉTODOS: Presentamos un paciente intervenido de catarata mediante facoemulsificación con implante de lente intraocular de cámara posterior plegable, sin incidencias ni complicaciones transoperatorias. Se le realizó evaluación biomicroscópica en el posoperatorio inmediato diagnosticándosele un síndrome tóxico del segmento anterior asociado a un desprendimiento gigante del epitelio pigmentado posterior del iris. Se tomaron fotos durante la evolución del paciente para documentar este raro signo clínico. RESULTADOS: Al provocar la dilatación pupilar farmacológica nos encontramos con la retracción de todas las capas anteriores del iris, mostrando por debajo al epitelio pigmentado posterior del iris sinequiado al lente intraocular y tan extensamente desprendido que simulaba un segundo iris. No encontramos este hallazgo clínico reportado en la literatura revisada. Denominamos este signo como iris en sayuela. CONCLUSIONES: El desprendimiento del epitelio pigmentado posterior del iris constituye un hallazgo clínico que puede aparecer raramente asociado al síndrome tóxico del segmento anterior y cuando es muy extenso puede presentarse de forma insólita como el signo del iris en sayuela

OBJECTIVE: To present a new clinical sign as a result of a huge posterior pigmented epithelium detachment of the iris in the course of at toxic anterior segment syndrome after a successful cataract surgery. METHOD: A patient who had undergone a cataract surgery by phacoemulsification with posterior chamber foldable intraocular lens implantation, without any incidence or transoperative complication. He was evaluated through biomicroscopy in the immediate postoperative period where a huge posterior pigmented epithelium detachment of the iris was diagnosed. Pictures were taken to document this unusual clinical sign. RESULTS: When performing the pharmacological pupil dilation, all the anterior layers of the iris were retracted, and the posterior pigmented epithelium was sinequiated to the IOL and so much detached that it looks like another iris. No reports of this clinical finding in the ophthalmologic literature were found. We named this sign as Iris in Underskirt. CONCLUSIONS: The posterior pigmented epithelium detachment represents a curious clinical finding that may be unusually associated to the toxic anterior segment syndrome. If it is very extensive, it may be appear as the unusual Iris in underskirt

Development of Toxic Anterior Segment Syndrome Immediately after Uneventful Phaco Surgery

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.