Toxic anterior segment syndrome: Update on the most common causes.

PURPOSE: To determine how the most common risk factors for toxic anterior segment syndrome (TASS) have evolved over the past decade. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Cross-sectional study. METHODS: This was a retrospective analysis of surveys from centers reporting cases of TASS from June 1, 2007, through March 1, 2012, and information from visits to afflicted sites between October 1, 2005, and December 31, 2011. Results from June 1, 2009, to March 1, 2012, were compared with those collected before June 1, 2009. RESULTS: The data from 130 questionnaires and 71 site visits were analyzed. The reporting centers performed approximately 69 000 surgeries and reported 1454 cases of TASS. Several trends were noted when comparing the most recent data with previously reported results. There was a 26% reduction in sites reporting inadequate handpiece flushing volumes and a 27% increase in sites using a deionized/distilled final rinse. At sites visited, there was a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents. However, there was a 21% increase in handling of intraocular lenses or instrument tips with gloved hands, a 47% increase in poor instrument maintenance, and a 34% increase in ultrasound bath use without adequate routine cleaning. CONCLUSIONS: Education may have improved some instrument-cleaning and perioperative practices that increase the risk for TASS; however, other practices may be headed in an unfavorable direction. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Toxic anterior segment syndrome: common causes.

PURPOSE: To identify the most common risk factors associated with toxic anterior segment syndrome (TASS). SETTING: Ophthalmic surgical centers in the United States, Argentina, Brazil, Italy, Mexico, Spain, and Romania. METHODS: A TASS questionnaire on instrument cleaning and reprocessing and extraocular and intraocular products used during cataract surgery was placed on the American Society of Cataract and Refractive Surgery web site. A retrospective analysis of questionnaires submitted by surgical centers reporting cases of TASS was performed between June 1, 2007, and May 31, 2009, to identify commonly held practices that could cause TASS. Members of the TASS Task Force made site visits between October 1, 2005, and May 31, 2009, and the findings were evaluated. RESULTS: Data from 77 questionnaires and 54 site visits were analyzed. The reporting centers performed 50 114 cataract surgeries and reported 909 cases of TASS. From January 1, 2006, to date, the 54 centers reported 367 cases in 143 919 procedures; 61% occurred in early 2006. Common practices associated with TASS included inadequate flushing of phaco and irrigation/aspiration handpieces, use of enzymatic cleansers, detergents at the wrong concentration, ultrasonic bath, antibiotic agents in balanced salt solution, preserved epinephrine, inappropriate agents for skin prep, and powdered gloves. Reuse of single-use products and poor instrument maintenance and processing were other risk factors. CONCLUSIONS: The survey identified commonly held practices associated with TASS. Understanding these findings and the safe alternatives will allow surgical center personnel to change their practices as needed to prevent TASS. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.