title: Late-onset toxic anterior segment syndrome.
abstract: We describe 6 cases that developed intraocular inflammation between 42 days and 137 days after implantation of an acrylic foldable intraocular lens (IOL) (ISert model 251) and failed to respond to antibiotic treatment. One eye required a vitrectomy and IOL removal, 2 eyes required irrigation of the capsule, and 5 eyes required systemic administration of steroids. The healing process took 30 to 108 days after onset. Simultaneous with our cases was an epidemic outbreak of sterile anterior segment inflammation with the same characteristics associated with the same IOL. The clinical features indicated late-onset toxic anterior segment syndrome. Analysis of the outbreak strongly suggested that toxicity of the aluminum used in the IOL production process was the cause. This contamination risk exists even with modern manufacturing technology.
  
  
  BACKGROUND
  Mr. Shibuya is an employee of Hoya Corporation Medical Division. No other author has a financial or proprietary interest in any material or method mentioned.
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan.
authors: Goichiro
authors: G
authors: Miyake
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan.
authors: Ichiro
authors: I
authors: Ota
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan. Electronic address: miyake@spice.or.jp.
authors: Kensaku
authors: K
authors: Miyake
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan.
authors: Masahiro
authors: M
authors: Zako
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan.
authors: Masayoshi
authors: M
authors: Iwaki
authors: From the Department of Ophthalmology (G. Miyake, Zako, Iwaki), Aichi Medical University, Aichi, the Shohzankai Medical Foundation (G. Miyake, Ota, K. Miyake), Miyake Eye Hospital, Nagoya, and Hoya Corporation Medical Division (Shibuya), Tokyo, Japan.
authors: Akihiko
authors: A
authors: Shibuya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015715:Corneal Edema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids