title: Outbreak of toxic anterior segment syndrome associated with glutaraldehyde after cataract surgery.
abstract: OBJECTIVE
  To present clinical findings of a cluster of cases of toxic anterior segment syndrome (TASS) after uneventful phacoemulsification cataract surgery.
  
  
  METHODS
  Department of Ophthalmology, Akdeniz University, Antalya, Turkey.
  
  
  METHODS
  Six eyes of 6 patients developed TASS after uneventful phacoemulsification cataract surgery with implantation of a 3-piece acrylic IOL performed by 2 ophthalmologists on the same day. Clinical findings included corneal edema, Descemet's membrane folds, anterior chamber reaction, fibrin formation, and irregular, dilated, and unreactive pupils.
  
  
  RESULTS
  Glutaraldehyde 2% solution was used inadvertently by the operating room staff who cleaned and sterilized reusable ocular instruments before autoclaving. None of the affected corneas improved. Additional surgical procedures were required and included penetrating keratoplasty, trabeculectomy, and glaucoma tube implantation.
  
  
  CONCLUSIONS
  Glutaraldehyde in concentrations generally used for cold sterilization is highly toxic to the corneal endothelium. The operating room staff involved in sterilizing instruments should be well educated about and careful to follow the protocols to properly clean and sterilize reusable ocular instruments.
authors.affiliation: Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey. drmustafaun@hotmail.com
authors.forename: Mustafa
authors.initials: M
authors.lastname: Unal
authors.forename: Iclal
authors.initials: I
authors.lastname: Yücel
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Akar
authors.forename: Asli
authors.initials: A
authors.lastname: Oner
authors.forename: Meryem
authors.initials: M
authors.lastname: Altin
mesh_terms: D000368:Aged; D000869:Anterior Eye Segment / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D015715:Corneal Edema / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D003886:Descemet Membrane / Q000187:drug effects / Q000473:pathology; D004196:Disease Outbreaks; D004202:Disinfectants / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005976:Glutaral / Q000009:adverse effects*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011681:Pupil Disorders / Q000139:chemically induced / Q000453:epidemiology; D013577:Syndrome; D014421:Turkey / Q000453:epidemiology
chemical_list: D004202:Disinfectants; D005337:Fibrin; D005976:Glutaral