title: Outbreak of late-onset toxic anterior segment syndrome after implantation of one-piece intraocular lenses.
abstract: OBJECTIVE
  To describe clinical findings associated with an outbreak of toxic anterior segment syndrome (TASS) after implantation of 1-piece intraocular lenses (IOLs; HOYA iSert(®) 251 and 255; HOYA Co Ltd, Tokyo, Japan) contaminated with aluminum.
  
  
  METHODS
  Multicenter observational retrospective case series.
  
  
  METHODS
  Cases developing TASS after IOL implantation from November 2011 to February 2013 were reported to the HOYA IOL-Related Endophthalmitis Investigation Committee. Infectious endophthalmitis was excluded. Data were collected on patient backgrounds, the time from IOL implantation to development of the first symptoms, clinical findings, treatment, and best-corrected visual acuity (BCVA) scores before and after treatment. BCVA data were converted into logMAR figures to allow for statistical analysis.
  
  
  RESULTS
  We identified 251 cases of late-onset TASS in patients of mean age 72.85 years treated in 183 hospitals. Common clinical features included the presence of anterior chamber cells (99.2%), conjunctival injection (41.4%), fibrinous inflammation (26.7%), and hypopyon (22.7%). Mean BCVA at the onset of ocular inflammation was 0.253 ± 0.424. The mean time from IOL implantation to development of the first symptoms was 38.44 ± 32.29 days. Of all eyes, 142 were treated with steroids and antibiotics, and 109 underwent surgery, including washing of the anterior chamber, removal of the IOL, and vitrectomy. Mean BCVA after treatment was 0.036 ± 0.242, significantly better than at the onset of ocular inflammation (P < .05).
  
  
  CONCLUSIONS
  This is the first report of an outbreak of late-onset TASS after implantation of a particular type of IOL.
authors: Department of Ophthalmology, Ehime University, Graduate School of Medicine, Ehime, Japan. Electronic address: t-suzuki@m.ehime-u.ac.jp.
authors: Takashi
authors: T
authors: Suzuki
authors: Department of Ophthalmology, Ehime University, Graduate School of Medicine, Ehime, Japan.
authors: Yuichi
authors: Y
authors: Ohashi
authors: Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors: Tetsuro
authors: T
authors: Oshika
authors: Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan.
authors: Hiroshi
authors: H
authors: Goto
authors: Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
authors: Akito
authors: A
authors: Hirakata
authors: Karasuyama Eye Clinic, Tokyo, Japan.
authors: Kimiko
authors: K
authors: Fukushita
authors: Miyata Eye Hospital, Miyazaki, Japan.
authors: Kazunori
authors: K
authors: Miyata
mesh_terms: D000368:Aged; D000535:Aluminum; D000869:Anterior Eye Segment / Q000187:drug effects / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004196:Disease Outbreaks; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D000535:Aluminum