title: Multistate outbreak of toxic anterior segment syndrome, 2005.
abstract: OBJECTIVE
  To present the findings of an outbreak of toxic anterior segment syndrome (TASS).
  
  
  METHODS
  Six states, 7 ophthalmology surgical centers, United States.
  
  
  METHODS
  Cases were identified through electronic communication networks and via reports to a national TASS referral center. Information on the procedure, details of instrument reprocessing, and products used during cataract surgery were also collected. Medications used during the procedures were tested for endotoxin using a kinetic assay.
  
  
  RESULTS
  The search identified 112 case patients (median age 74 years) from 7 centers from July 19, 2005, through November 28, 2005. Common presenting clinical features included blurred vision (60%), anterior segment inflammation (49%), and cell deposition (56%). Of the patients, 100 (89%) had been exposed to a single brand of balanced salt solution manufactured by Cytosol Laboratories and distributed by Advanced Medical Optics as AMO Endosol. Two patients continued to have residual symptoms. There were no reports of significant breaches in sterile technique or instrument reprocessing. Of 14 balanced salt solution lots, 5 (35%) had levels exceeding the endotoxin limit (0.5 EU/mL). Based on these findings, the balanced salt solution product was withdrawn, resulting in a termination of the outbreak.
  
  
  CONCLUSIONS
  This is the first known report of an outbreak of TASS caused by intrinsic contamination of a product with endotoxin. Ophthalmologists and epidemiologists should be aware of TASS and its common causes. To facilitate investigations of adverse outcomes such as TASS, those performing cataract surgeries should document the type and lot numbers of products used intraoperatively.
authors: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, PHS/DHHS, 1600 Clifton Road NE, Atlanta, GA 30333, USA. pkutty@cdc.gov
authors: Preeta K
authors: PK
authors: Kutty
authors: Terri S
authors: TS
authors: Forster
authors: Carol
authors: C
authors: Wood-Koob
authors: Nancy
authors: N
authors: Thayer
authors: Robert B
authors: RB
authors: Nelson
authors: Stanley J
authors: SJ
authors: Berke
authors: Lillian
authors: L
authors: Pontacolone
authors: Thomas L
authors: TL
authors: Beardsley
authors: Henry F
authors: HF
authors: Edelhauser
authors: Matthew J
authors: MJ
authors: Arduino
authors: Nick
authors: N
authors: Mamalis
authors: Arjun
authors: A
authors: Srinivasan
mesh_terms: D000085:Acetates; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000473:pathology*; D004196:Disease Outbreaks; D004338:Drug Combinations; D004340:Drug Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals; D012772:Shock, Septic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012965:Sodium Chloride; D013577:Syndrome; D014481:United States / Q000453:epidemiology; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D008903:Minerals; D012965:Sodium Chloride