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Prefilled syringe viscoelastic as an etiology of toxic anterior segment syndrome

Poster Details

First Author: T.Althomali SAUDI ARABIA

Co Author(s):                  

Abstract Details


To present etiologic investigation of two consecutive clusters of toxic anterior segment syndrome (TASS) due to use of diposable prefilled syringe viscoelastic.


Tadawi Surgical Center, Taif, Saudi Arabia


This study presents two consecutive clusters of TASS in 15 of the 24 uneventful surgeries (22 phacoemulsifications, 1 phacotrabeculectomy, and 1 ICL implantation) and the investigation carried out to find the etiology.


After the occurrence of 1st cluster of TASS, investigation was done to explore sterilization related etiology. Although no lacunae were identified, multiple changes in cleaning process were implemented. Despite ensuring proper sterilization, a second cluster of TASS was encountered inthe following OT. Further, several other factors (antibiotics, ointments, IOL, inadequate BSS, viscoelastics) were considered. Most of them were ruled out after investigation. Finally,the newly introduced viscoelastic I-visc® 1.4% sodium hyaluronate (I medical, i-Medical Ophthalmic International GmbH, Heidelberg / Germany) was replaced with previously inuse sodium hyaluronate 1.5% and lidocaine hydrochloride 1%, (Visthesia, CZ, Germany) in further surgeries. No further, TASS incident was encountered after replacing the viscoelastic.


Investigation revealed that I-visc®1.4% was the etiologic factor. While TASS due to residual denatured OVDs is a common knowledge, current study brings out that that even disposable viscoelastic material supplied in prefilled syringes can have an etiology of TASS. This may either be due to endotoxin contamination during manufacturing or due to some packaging material. FINANCIAL INTEREST: NONE

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