Toxic anterior segment syndrome after uncomplicated cataract surgery

PURPOSE. To evaluate the anterior segment examination findings and the response to medical therapy of patients who had toxic anterior segment syndrome (TASS) after uncomplicated cataract surgery. METHODS. Fourteen eyes of 14 patients were enrolled in the study. Visual acuity, biomicroscopic anterior segment examination, intraocular pressure measurement, and fundus examination were performed to assess TASS occurring during postoperative 12-48 hours after uncomplicated phaco surgery. The visual impairment, corneal edema, tyndallization, fibrin formation, hypopyon, vitritis, and response to steroid therapy were evaluated prospectively. RESULTS. After topical steroid therapy lasting for 1 week, visual acuity improved in 11 eyes. No significant visual improvement occurred in 3 eyes. Significant corneal edema was found in 4 and mild corneal edema was observed in the other 10 eyes. Fibrin reaction occurred in 5 and tyndallization in various degrees was positive in all eyes. There was a 1-mm hypopyon in 1 patient. There was no sign of vitritis and steroid therapy was effective in all of the patients. In addition to topical treatment with steroid and antibiotic drops; systemic and subconjunctival steroids were used in 3 patients who had fibrin formation and in one patient who had hypopyon. CONCLUSIONS. After uncomplicated cataract surgery, toxic anterior segment may occur in the early postoperative period, which is treated successfully with steroids. More studies are needed to understand the multifactorial risk factors affecting the etiopathogenesis of this syndrome. (Eur J Ophthalmol 2010: 20: 106-14)