Toxic Anterior Segment Syndrome With Intracameral Moxifloxacin

to show that high dose of intracameral moxifloxacin can cause TASS even if it is preservative free 

The memorial institute for ophthalmic research (MIOR)

A 60 y old female presented drop of vision in left eye , after examination I decided to do cataract surgery under local anaesthesia for her.  the patient underwent routine phacoemulsification and insertion of a single-piece acrylic intraocular lens implant (IOL) (Acrysof) Intracameral preservative-free moxifloxacin (Vigamox) was used at the end of the case (I noticed that the total volume I injected was  0.5 cc which is large dose than usual ).  1^st day post –op I found very sever inflammation , the fluid in the eye was dark , aggressive membranes in AC and around IOL , vision was HM  mild pain, no chemosis . U/S  showed completely free post seg. So I decided  to fu without interference .

 I found the same pic in the 2^nd day so I diagnosed the patient as TASS and I decided to do AC wash and started to review literature about the causes of TASS  and I found that  Intracameral Moxifloxacin can cause this .the patient continued on very high doses of topical steroids

The patient started to improve and to took about 4 months until complete resolve of ant seg occurred leaving large areas of iris depigmentation , very week pupillary reaction , dense PCO and high IOP . I continued on anti glaucoma until IOP controlled and did YAG capsulotomy  and the final UCVA reached 0.6 that improve by glasses to 0.8

High dose of intracameral moxifloxacin can cause TASS even if it is preservative free

We should differentiate between endophthmitis and TASS