Toxic anterior segment syndrome.
Toxic anterior segment syndrome (TASS) is a sterile postoperative inflammatory reaction caused by a noninfectious substance that enters the anterior segment, resulting in toxic damage to intraocular tissues. The process typically starts 12 to 48 hours after cataract/anterior segment surgery, is limited to the anterior segment of the eye, is always Gram stain and culture negative, and usually improves with steroid treatment. The primary differential diagnosis is infectious endophthalmitis. Review of the literature indicates that possible causes of TASS include intraocular solutions with inappropriate chemical composition, concentration, pH, or osmolality; preservatives; denatured ophthalmic viscosurgical devices; enzymatic detergents; bacterial endotoxin; oxidized metal deposits and residues; and factors related to intraocular lenses such as residues from polishing or sterilizing compounds. An outbreak of TASS is an environmental and toxic control issue that requires complete analysis of all medications and fluids used during surgery, as well as complete review of operating room and sterilization protocols.
John A. Moran Eye Center, Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. nick.mamalis@hsc.utah.edu
Nick
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Mamalis
Henry F
HF
Edelhauser
Daniel G
DG
Dawson
Jesse
J
Chew
Russell M
RM
LeBoyer
Liliana
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Werner
D000869:Anterior Eye Segment / Q000187:drug effects* / Q000473:pathology; D002387:Cataract Extraction; D003937:Diagnosis, Differential; D009877:Endophthalmitis / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D019654:Lens Implantation, Intraocular; D009883:Ophthalmic Solutions / Q000009:adverse effects*; D011183:Postoperative Complications; D013577:Syndrome
D009883:Ophthalmic Solutions