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Development of toxic anterior segment syndrome immediately after uneventful phaco surgery.

Choi JS, Shyn KH - Korean J Ophthalmol (2008)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

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.

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Related in: MedlinePlus

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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Figure 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.

Mentions: Visual acuity after 1 week ranged between hand motion and 0.1 (Fig. 1). Steroids and 5% NaCl solution were used as treatment. Five out of 15 patients stopped coming to the Medical Center within a month after the surgery. Another 5 of the 15 patients underwent penetrating keratoplasty (Fig. 2 and 3) with a donated cornea. The final visual acuity of these patients improved to between 0.1 and 0.5. However, one patient suffered from graft rejection which made visual acuity close to light perception. Four patients showed an increase in intraocular pressure and had to receive topical treatments for glaucoma. The increased intraocular pressure of one patient in this group was not controlled with medication. This patient received a trabeculectomy. Malignant glaucoma developed and visual acuity was not restored (Table 3).


Development of toxic anterior segment syndrome immediately after uneventful phaco surgery.

Choi JS, Shyn KH - Korean J Ophthalmol (2008)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629913&req=5

Figure 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.
Mentions: Visual acuity after 1 week ranged between hand motion and 0.1 (Fig. 1). Steroids and 5% NaCl solution were used as treatment. Five out of 15 patients stopped coming to the Medical Center within a month after the surgery. Another 5 of the 15 patients underwent penetrating keratoplasty (Fig. 2 and 3) with a donated cornea. The final visual acuity of these patients improved to between 0.1 and 0.5. However, one patient suffered from graft rejection which made visual acuity close to light perception. Four patients showed an increase in intraocular pressure and had to receive topical treatments for glaucoma. The increased intraocular pressure of one patient in this group was not controlled with medication. This patient received a trabeculectomy. Malignant glaucoma developed and visual acuity was not restored (Table 3).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus