Toxic Anterior Segment Syndrome DR NSD Raju Past President All India Ophthalmological Society Chairman International Relations Wing AIOS 2. Duffy RE, Brown SE, Caldwell KL, Lubniewski A, Anderson N, Edelhauser H, et al. Toxic Anterior Segment Syndrome (TASS) is an acute post-operative intraocular inflammation caused by the introduction of a noninfectious toxic agent into the anterior chamber of the eye at the time of surgery.1 Cellular necrosis and damage to the endothelium cause a severe inflammation which can lead to permanent impaired The Food and Drug Administration's Proactive Toxic Anterior Segment Syndrome Program. The use of these antibiotics within the BSS solution for the prevention of endophthalmitis has largely fallen out of favor.There has been intense interest in the use of intracameral antibiotics at the conclusion of surgery for the prevention of endophthalmitis.
Intraocular inflammation of denatured viscoelastic substance in cases of cataract extraction and lens implantation. Sterile hypopyon following intraocular lens surgery. In addition, ultrasound and irrigation/aspiration handpieces used during phacoemulsification may allow a buildup of residual OVD and cortex that could lead to inflammation when these instruments are used in subsequent cases.
However, this can be difficult, because both conditions can present in a similar fashion.The hallmark of TASS is its rapid onset, usually within 12-24 hours. Eydelman MB, Tarver ME, Calogero D, Buchen SY, Alexander KY. Fibrin is variable. In refractory glaucoma, the eye pressure should be closely monitored. A cooperative investigation by the Centers for Disease Control (CDC) and the University of Utah analyzed 112 cases from this outbreak. Full examination is very important.
Comparative toxicity of intraocular irrigating solutions on the corneal endothelium. 2002 Journal Club June 14, 2006 Terry J. Alexandrou, MD Department of Ophthalmology and Visual Science University of Chicago 2.
Unlike infectious endophthalmitis, vitreous inflammation is rare, and, if it occurs, it is considered to be the result of a posterior diffusion from the anterior chamber.The intraocular pressure can be elevated secondary to trabecular meshwork damage.Cystoid macular edema has been reported in a few cases.Unlike infectious endophthalmitis, TASS often rapidly improves after topical steroids are instituted, which serves as a distinguishing feature from infectious endophthalmitis.The following table summarizes the classic presentation of TASS and infectious endophthalmitis to help differentiate the two entities.Table 1. Possible etiologic agents include intraocular solutions, intraocular anesthetics and antibiotics, residues of materials such as ophthalmic viscosurgical devices (OVDs), and remnants of materials used to clean and sterilize ophthalmic instruments.
Most patients with toxic anterior segment syndrome will develop symptoms within 12 to 24 hours of the surgery.
Nizamani NB, Bhutto IA, Talpur KI. Toxic Anterior Segment Syndrome: Etiology. In rare cases, depending on the severity there may be a need for systemic steroid treatment. Download Referat TASS Fiam (Toxic Anterior Segment Syndrome) Comments. TASS is responsive to topical steroids in most cases. Toxic endothelial cell destruction of the cornea after routine extracapsular cataract surgery. If these instruments are not properly flushed following cataract surgery, the residual OVD may be subsequently broken down during the process of sterilization.
The most commonly used intracameral anesthetic is 1% MPF (methylparaben-free) lidocaine. Johnston J. Fourteen eyes of 14 patients were enrolled. Toxic anterior segment syndrome-an updated review. Of note, in a major outbreak of 147 eyes published by Oshika et al, 29.3% cases required surgery, including irrigation of the anterior chamber, vitrectomy, and IOL removal. The condition is responsive to topical steroids in most cases. Wounds that are poorly constructed and are not water-tight may allow ingress of topical solutions or ointments into the anterior segment.