Posters

Management of eight cases of toxic anterior segment syndrome (Tass) after uncomplicated cataract-surgery

Poster Details

First Author: M.Cascella ITALY

Co Author(s):    A. Dell'olio                    

Abstract Details

Purpose:

Possible TASS causes include intraocular solutions with inappropriate chemical composition, pH, or osmolality; preservatives; denatured viscosurgical devices; enzymatic detergents; bacterial endotoxin; deposits and residues. Ophthalmologists should be aware of TASS and its common causes. Most common complaint that patients with TASS have is blurred vision. Pain is usually absent which is distinct from cases of postop-infectious endophthalmitis .The aim of this study is to evaluate clinical signs and to describe the different therapeutic approaches in the treatment of eight out sixteen uncomplicated cataract surgery patients affected by suspected sterile endophthalmitis (TASS) secondary to the use of a new viscoelastic (OVDs).

Setting:

Ophtalmic Departement, Day Surgery Unit-F.Jaia Hospital, Conversano, Bari, Italy

Methods:

Sixteen eyes of sixteen patients were examinated the day after uncomplicated faco-surgery. During surgery eight out of sixteen patients used a new viscoelastic(OVDs) for the IOL implant that had been completely removed at the end of surgery. The patients checked the following day in several outpatient citycenters. Visual impairement,biomicroscopic anterior segment examination, intraocular pressure measurement and ocular ultrasound due to inexplorability of fundus, were performed. Non-univocal therapeutic approaches were established: those without correct diagnosis of sterile endophthalmitis underwent complete vitrectomy with IOL removal and culture examination (as for the forms infectious) in others, topical and systemic steroid therapy was prescribed.

Results:

Tass occuring during post-operative 12-24 hours after the surgery in the eight patients. With common clinical signs: diffuse corneal oedema, 2 mm hypopion and fibrina formation, moderate or no redness, very slight pain, all findings, were evaluated, and finally the response to different therapeutic approach were asses. The complete resolution of TASS clinical signs with excellent functional recovery(BCVA 20/20 ) was not identical in all patients, much faster, and maximal in those undergoing simply cortisone therapy, and worse in patients mistakenly undergoing complete vitreoretinal surgery and IOL removal for an excessively prudent approach.

Conclusions:

The clinical hallmark of TASS is that the inflammation presents with a relatively immediate onset and is sterile with Gram-stain and cultures negative. Outcomes are usually excellent, but delayed treatment and severe cases may result in glaucoma and persisting corneal edema requiring penetrating keratoplasty. TASS due to residual denatured ophtalmic viscosurgical device(OVDs) is known, our experience highlights the importance of sharing data, as the day after surgery it is not easy differential diagnosis between forms of infectious endophthalmitis and no: Sharing is essential to trace the causes and recognize the etiology so as to choose the correct treatment.

Financial Disclosure:

None