An Unusual Case Of Toxic Anterior Segment Syndrome After Uneventful Phacoemulsification In An Elderly Female With Intumescent Cataract On 8Th Postoperative Day.

To recognise delayed onset of Toxic anterior segment syndrome (TASS) , to recognise the cause  of sterile inflammatory reaction and diminished vision after one week of surgey .

AROGYAM EYE CLINIC, MUMBAI

TASS is a acute severe intraocular inflammation seen within 1-2 days of anterior segment surgery, it can manifest as delayed onset also, like in our patient.

A 55 year old lady was operated for intumescent cataract , she underwent an uneventful phacoemulsification with clear corneal incision with hydrophobic IOL. First postoperative day slit examination showed a quiet eye with clear cornea and IOL in sulcus , vision being 20/30 she had and similar findings on 4th postoperative follow up.

Patient came on 8th postoperative day with complains of diminess of vision and watering , on slit lamp examination she  had corneal oedema limbus to limbus, no hypopyon ,no flare, no vitreos inflammation signs , retinal examination was normal too , IOP was within normal limits . Anterior segment OCT was done to rule out Descemet membrane detachment.

She was started on eyedrops Prednisolone acetate 1% one hourly , Moxifloxacin 0.5%  4 times , Timolol maleate and Dorzolamide Hcl combination twice a day and monitored daily , not much improvement was seen in the following days , hence a Anterior chamber (AC) wash was done , the cornea cleared up significantly next day of AC wash. She did well in next two weeks with steriods tapered and vision improved to 20/80.

TASS is a specific non infectiious condition typically manifests within 12-48 hours of surgery, it also has a delayed onset reaction with signs of inflammation on cornea alone like in this patient . It is important to differentiate TASS from infectious bacterial endophthalmitis .

It is important to follow proper guidelines for sterilisation and cleaning of surgical instruments, training of OT staff, also to emphasize the importance thorough AC wash even below the IOL during catract surgey .

It is important to understand the timely intervention  of doing AC wash after TASS has occurred to remove any toxic debris or retained viscoelastic substance from the anterior chamber.