title: Toxic anterior segment syndrome following deep anterior lamellar keratoplasty.
abstract: We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS) that developed after undergoing deep anterior lamellar keratoplasty (DALK). She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA) was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber.
authors.affiliation: Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Sevimli
authors.affiliation: Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Remzi
authors.initials: R
authors.lastname: Karadag
authors.affiliation: Department of Ophthalmology, Istanbul Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Cakici
authors.affiliation: Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bayramlar
authors.affiliation: Department of Ophthalmology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors.forename: Seydi
authors.initials: S
authors.lastname: Okumus
authors.affiliation: Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
authors.forename: Unsal
authors.initials: U
authors.lastname: Sari
mesh_terms: D000328:Adult; D000869:Anterior Eye Segment / Q000473:pathology*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016039:Corneal Transplantation / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use; D004487:Edema; D009877:Endophthalmitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D013577:Syndrome; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone