Toxic anterior segment syndrome caused by autoclave reservoir wall biofilms and their residual toxins

Sorenson, Andrew L.; Sorenson, Robert L.; Evans, David J.

doi:10.1016/j.jcrs.2016.08.030

Cited by 19 publications

(19 citation statements)

References 13 publications

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“…A significant number of reported TASS cases has occurred as clusters of outbreaks. [11][12][13][14][15] We experienced a TASS outbreak in 2 tertiary hospitals in our region. The major causes implicated in TASS outbreaks have included inadequate cleaning of surgical instruments, contamination of surgical instrument or IOLs, and adverse drug reactions to viscoelastic substances and intracameral use of cefuroxime, [2][3][4][5][6][7][8] although no explainable causes have been identified in 51.7% of 60 TASS cases after uneventful cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model

Imamachi

Sugihara

Ikeda

et al. 2021

American Journal of Ophthalmology

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To report a cluster of cases of toxic anteriorsegment syndrome (TASS) in eyes implanted with a specific foldable acrylic intraocular lens (IOL) model. • DESIGN: Retrospective case series. • METHODS: The medical records were reviewed for 7 eyes of 4 patients diagnosed with TASS after cataract surgery at Shimane University and Matsue Red Cross Hospital between July and November 2020. • RESULTS: Among the 162 eyes implanted with the Lentis Comfort/LS-313 MF15 IOL, acute anterior chamber (AC) inflammation with fibrin formation developed 1-15 days after uneventful surgeries in 7 (4.3%) eyes (cataract surgery alone, n = 4 eyes; combined cataract and minimally invasive glaucoma surgery, n = 3 eyes). Other than local steroid use, fibrin membrane removal, YAG laser membranotomy, pars plana vitrectomy, and AC washout were performed to treat inflammation and/or secondary angle closure due to pupillary obstruction. • CONCLUSION: We experienced a cluster of TASS cases in eyes implanted with the Lentis Comfort/LS-313 MF15 IOL in a short period of time. To our knowledge, this is the first report of TASS associated with this IOL.

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Section: Discussionmentioning

confidence: 99%

Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model

Imamachi

Sugihara

Ikeda

et al. 2021

American Journal of Ophthalmology

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“…If presenting with corneal edema and endothelial dysfunction 12–48 h after anterior segment surgery, acute toxic anterior segment syndrome (TASS) should be considered. This is by definition a non-infectious inflammatory reaction with many potential causes including ointments, preservatives, retention of sterilization detergent, abnormal pH or salt concentration, trypan blue, trace metal deposits, and denatured viscoelastic material [72–77]. These causes of corneal edema after posterior chamber intraocular lens implantation discussed above are not all true endotheliitis, yet should be considered in the differential of possible corneal endotheliitis.…”

Section: Procedural Causesmentioning

confidence: 99%

A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment

et al. 2019

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The corneal endothelium plays an integral role in regulating corneal hydration and clarity. Endotheliitis, defined as inflammation of the corneal endothelium, may disrupt endothelial function and cause subsequent visual changes. Corneal endotheliitis is characterized by corneal edema, the presence of keratic precipitates, anterior chamber inflammation, and occasionally limbal injection, neovascularization, and co-existing or superimposed uveitis. The disorder is classified into four subgroups: linear, sectoral, disciform, and diffuse. Its etiology is extensive and, although commonly viral, may be medication-related, procedural, fungal, zoological, environmental, or systemic. Not all cases of endothelial dysfunction leading to corneal edema are inflammatory in nature. Therefore, it is imperative that practitioners consider a broad differential for patients presenting with possible endotheliitis, as well as familiarize themselves with appropriate diagnostic and therapeutic modalities.

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“…Depending on the severity of inflammation, other symptoms may be present, such as pain, conjunctival injection or chemosis, hypopyon, corneal edema, keratic precipitates, anterior vitreous opacities, macular edema and visual deterioration [ 1 , 6 , 7 , 13 ]. Most reported cases of TASS have been anecdotal, and therefore the clinical manifestations vary widely as shown in Table 1 [ 9 , 10 , 14 – 17 ]. However, in 2015 and 2017, two large case-series studies ( n = 251 and n = 147) were conducted in Japan [ 8 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…no.) Number of cases Onset (days after the surgery) Inciting agents Clinical presentations Managements (n) Visual outcomes (n) Miyake et al [ 19 ] 6 42–167 IOL (ISert model 251, Hoya) Chemosis, Ciliary injection, Decreased BCVA, Corneal edema, Anterior chamber reaction, hypopyon Vitretomy and IOL removal (1), Capsule irrigation (2), Medical treatment only (5) BCVA 20/100 (1), BCVA ≥20/30 (5) Suzuki et al [ 18 ] 251 38.44 ± 32.29 Range:0–161 IOL (ISert model 251 and 255, Hoya) Anterior chamber reaction (99.2%), conjunctival injection (41.4%) Hypopyon (22.7%) Corneal edema (19.1%) Keratic precipitates (27.9%) Medical treatment only (142), Surgical intervention: vitrectomy (49), IOL removal (22), chamber irrigation (51) BCVA 0.036 ± 0.242 logMAR Sorenson et al [ 10 ] 10 1–7 Bacterial biofilm contamination of autoclave reservoir Anterior chamber reaction (10), Hypopyon (3), Corneal edema (1), Anterior vitreous reaction (4) Medical treatment only (3), Vitreous tap and intravitreal injection (7) No light perception (1), BCVA≥20/30 (9) Ohika et al [ 8 ] 147 13.1 ± 16.4 Range: 1–88 IOL (Acrysof, Alcon) Anterior chamber reaction (97.2%), Conjunctival injection (39.8%), Fibrinous inflammation (43.1%) Hypopyon (22.7%) Corneal edema (15.6%) Keratic precipitates (21.6%), Ocular pain (9.5%) Medical treatment only (104), Surgical intervention: vitrectomy (21), IOL removal (10), chamber irrigation (33) BCVA> 20/40 (143), BCVA≤20/40 (4) Moyle et al [ 9 ] 11 1 unknown Corneal edema (11), anterior chamber reaction (10), Inflammatory plaque on IOL (5), hypopyon (3), fibrin reaction (6), mild pain (2) Medical treatment only (11) BCVA = 20/20 (11) Sengupta et al [ 7 ] 60 …”

Section: Introductionmentioning

confidence: 99%

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Toxic anterior segment syndrome-an updated review

2018

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BackgroundToxic anterior segment syndrome (TASS) can be a rare complication of anterior segment surgery. Here we reviewed the most recent advances in the understanding of TASS.MethodsEnglish articles related to TASS were retrieved from “PubMed” using the following keywords; “toxic anterior segment syndrome” or “TASS”. The authors of this paper reviewed all the retrieved literature and critical findings were summarized.ResultsThe onset of TASS can vary from hours to months. The clinical manifestations are also variable. The causes of TASS are broad and continue to expand and could not be elucidated in over half of the reported cases. Prompt and thorough investigation to explore the causes of TASS is critical. Surgeons should be fully aware and updated regarding possible etiologies and make ceaseless efforts to prevent TASS. This effort begins with establishing TASS prevention protocols and regularly training surgical staff. Proper cleaning of surgical instruments is critical and should follow the guidelines set by The American Society of Cataract and Refractive Surgery TASS Task Force. When TASS occurs, sharing information with other ophthalmologists and reporting new causes is crucial for the prevention of outbreaks.ConclusionsAnterior segment surgeons should be reminded that TASS is mostly preventable by the establishment of TASS prevention protocols, regular surgical staff training and thorough adherence to recommendations for cleaning and sterilizing intraocular surgical instruments.

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Toxic anterior segment syndrome caused by autoclave reservoir wall biofilms and their residual toxins

Abstract: None of the authors has a financial or proprietary interest in any material or method mentioned.

Cited by 19 publications

References 13 publications

Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model

Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model

A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment

Toxic anterior segment syndrome-an updated review

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