title: Toxic anterior segment syndrome following penetrating keratoplasty.
abstract: OBJECTIVE
  To describe an outbreak of toxic anterior segment syndrome (TASS) following penetrating keratoplasty (PK) and to examine its possible causes.
  
  
  METHODS
  Owing to a series of TASS following PK between June 6, 2007, and October 2, 2007, we reviewed the records of all patients who had undergone PK during that time. In addition to routine microbial tests on organ culture media, we looked for specific pathogens and endotoxins in all of the materials used for organ culture or PK. Furthermore, we analyzed all of the perioperative products and instrument processing.
  
  
  RESULTS
  Of the 94 patients who underwent PK, we observed 24 cases of postoperative sterile keratitis. Causal research revealed that the accumulation of cleaning substances or heat-stable endotoxins on the surface of the routinely used guided trephine system was most likely responsible for the TASS.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report on TASS following PK. Suboptimal reprocessing of surgical instruments may be an important cause of TASS as in this series the TASS-like symptoms resolved after modified instrument-cleaning procedures. The standardization of protocols for processing reusable trephine systems might prevent outbreaks of TASS following PK.
authors.affiliation: University Eye Hospital, Freiburg, Germany. philip.maier@uniklinik-freiburg.de
authors.forename: Philip
authors.initials: P
authors.lastname: Maier
authors.forename: Florian
authors.initials: F
authors.lastname: Birnbaum
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
mesh_terms: D000869:Anterior Eye Segment / Q000473:pathology*; D002452:Cell Count; D015925:Cryopreservation; D004196:Disease Outbreaks; D004728:Endothelium, Corneal / Q000473:pathology; D004866:Equipment Contamination; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D009926:Organ Preservation; D012772:Shock, Septic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013577:Syndrome