Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery.
OBJECTIVE
To report clinical and laboratory findings of 8 cases of toxic anterior segment syndrome (TASS) related to an oily substance in the anterior chamber of patients following cataract surgery with intraocular lens (IOL) implantation.


METHODS
John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.


METHODS
Eight patients had uneventful phacoemulsification by the same surgeon via clear corneal incisions with implantation of the same 3-piece silicone IOL design. Postoperative medications included antibiotic/steroid ointment and pilocarpine gel; each eye was firmly patched at the end of the procedure. On the first postoperative day, some patients presented with diffuse corneal edema, increased intraocular pressure, and an oily film-like material within the anterior chamber coating the corneal endothelium. The others presented with an oily bubble floating inside the anterior chamber, which was later seen coating the IOL. Additional surgical procedures required included penetrating keratoplasty, IOL explantation, and trabeculectomy. Two corneal buttons were analyzed histopathologically. Two explanted IOLs had gross and light microscopic analyses (as well as surface analyses of 1 of them), and 4 other explanted IOLs had gas chromatography-mass spectrometry.


RESULTS
Pathological examination of the corneas showed variable thinning of the epithelium with edema. The stroma was diffusely thickened and the endothelial cell layer was absent. Evaluation of the explanted IOLs confirmed the presence of an oily substance coating large areas of their anterior and posterior optic surfaces. Gas chromatography-mass spectrometry of the lens extracts identified a mixed chain hydrocarbon compound that was also found in the gas chromatography-mass spectrometry analyses of the ointment used postoperatively.


CONCLUSIONS
The results indicate that the ointment gained access to the eye, causing the postoperative complications described. These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment.
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
Liliana
L
Werner
Jeffrey H
JH
Sher
Joel R
JR
Taylor
Nick
N
Mamalis
Wesley A
WA
Nash
James E
JE
Csordas
George
G
Green
E Peter
EP
Maziarz
X Michael
XM
Liu
D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects / Q000473:pathology; D000869:Anterior Eye Segment / Q000187:drug effects* / Q000473:pathology; D015715:Corneal Edema / Q000139:chemically induced / Q000473:pathology; D020878:Device Removal; D009877:Endophthalmitis / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000009:adverse effects*; D018918:Phacoemulsification; D011183:Postoperative Complications; D012086:Reoperation; D012826:Silicone Elastomers; D013577:Syndrome
D009824:Ointments; D012826:Silicone Elastomers