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

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 NdYAG 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 NdYAG laser treatment can effectively remove inflammatory cell deposits mingled with greasy oil material.