Tass Following Ipcl Implantation In A Myopic Eye

To report a case of TASS following IPCL implantation in a myopic eye. 

TASS (Toxic Anterior Segment Syndrome) is a rare condition charecterized by postoperative inflammation after uneventful anterior segment surgery that occurs within the first 12-48 hours after surgery. Several etiologies including retained lens material, viscosurgical devices, glove talc, intracameral antibiotics and endotoxin contamination of balanced salt solution have been identified.

A 27 year old male patient who underwent IPCL implantation in left eye for high myopia presented with complaints of diminution of vision, redness and mild pain 4 days following surgery. Surgery was uneventful and patient had vision of 20/30 on postoperative day 1. On examination, visual acuity was 20/600. Anterior segment examination under slit lamp biomicroscopy showed mild corneal edema, with anterior chamber cells and flare, dilated pupil with pupillary membrane and hypopyon. Intraocular pressure was elevated on applanation tonometry.  B scan ultrasonography showed moderate echoes suggestive of inflammation.  Patient was started on topical antibiotics and anti glaucoma medications. He was given intravitreal antibiotic (vancomycin + ceftazidime) under topical anaesthesia and AC tap was done in the same sitting. The AC tap did not show any microorganisms in Gram’s stain and in culture after 48 hours. Following this, the patient was started on topical and oral steroids along with the previous medications. On follow up, corneal edema reduced, anterior chamber reaction decreased along with the intraocular pressure. B scan ultrasonography also showed resolution of echoes and vision improved to 20/30. 

In conclusion TASS is a rare complication after phakic IOL implantation. Early diagnosis and management is essential to prevent long-term sequelae. The most important step is prevention with adequate intraoperative manipulation of the ICL, surgical instruments and intracameral fluids.