Mild or early cases will respond to steroids rapidly as evidenced by clearing of the inflammation and decrease in intraocular pressure. Most TASS patients respond well to topical corticosteroids (1% Prednisolone acetate) given hourly. The patient may need cornea transplant, glaucoma surgery or both. On rare severe cases, there is a need for further surgical intervention. The patient should be followed closely and evaluated by a retina specialist to rule out infectious causes. In rare cases, depending on the severity there may be a need for systemic steroid treatment. Most patients do well with medical management using topical steroids. Bacterial culture for both aerobic and non aerobic.Both aqueous and vitreous taps are sent for culture to investigate for an infectious process. In these situations, the patient should have an ultrasound B-scan to rule out any posterior reaction. The posterior pole may be difficult to view if there is severe anterior chamber reaction. Patients tend to respond very well to topical steroid treatment.Īll patients should have a slit lamp exam and dilated fundus exam. The anterior chamber should be examinied carefully for anterior chamber reaction, intraocular pressure and severity of vision loss. The physician should note the time of onset after eye surgery in conjunction with the patient's symptoms. Good response to topical ophthalmic steroid dropsĬlinical diagnosis is made based on many factors.Lack of bacterial or fungal growth from cultures of intraocular taps.Corneal edema extending from limbus to limbus.Acute severe inflammatory reaction of anterior chamber within 12-48 hours after surgery.Vision loss or blurry vision within 12-48 hours after surgery.Evaluation of visual acuity, pupil size and reaction, slit-lamp exam, eye pressure and dilated fundus exam. The staff and surgeon should be well aware of the SOPsĪcute onset of anterior chamber inflammation 12-48 hours after uneventful anterior segment surgeryįull examination is very important.Standard and clear operative and instrument processing procedures (SOP) need to be implemented.Adequate sterlization of instruments and tubing according to the manufacturer's protocol.Use of fresh ophthalmic visosurgical devices.Avoid preservatives in intraocular solutions, intracameral medications or irrigating solutions.Good filtration of the BBS at the manufacturing site to eliminate particulate contamination and endotoxins.Use of proper balance salt solution (BSS) with the correct pH, osmolarity, and ionic composition.The response is typically apparent and symptomatic 12-48 hours after surgery. TASS is an activation of inflammatory cascades in the anterior chamber in response to external material or inappropriate solutions during cataract surgery. There is no bacterial or fungal infection, although one potential cause of the inflammatory reaction is secondary to bacterial endotoxins. This is a sterile anterior segment reaction. Severe inflammatory reactions in response to the contamination, toxins, imbalanced solutions, medications or preservatives in the medications. Inadequate flushing of instruments between cases resulting in build-up of ophthalmic viscosurgical devices (OVD).Inadequate sterilization of surgical instruments and tubing.Intraocular medications (antibiotics in the irrigation solutions or intracameral antibiotics).Denatured Ophthalmic Viscosurgical Devices (OVD).
Intraocular irrigating solutions with abnormal PH, osmolarity or ionic composition.Bacterial endotoxins or particulate contamination of balanced salt solutions.The etiology of TASS may be multi-factorial with numerous potential causes. TASS is responsive to topical steroids in most cases. TASS presents within 12-24 hours after surgery where infectious endophthalmitis typically develops 2-7 days after surgery. TASS is a form of sterile, noninfectious endophthalmitis with or without pain, marked decrease in vision, diffuse corneal edema that extends limbus to limbus, photophobia and severe anterior chamber reaction, occasionally with hypopyon. Toxic anterior segment syndrome (TASS) is an acute severe intraocular inflammation accompanied by diffuse corneal edema within 1-2 days of anterior segment surgery which is most commonly associated with cataract surgery.
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