Two Cases Of Toxic Anterior Segment Syndrome (Tass) In One Morning: Investigating The Cause.

To report two cases of Toxic Anterior Segment Syndrome (TASS) occurring in the same operating room on the same morning. This report includes a detailed follow-up of the patients, focusing on their visual and refractive outcomes. We discuss the management of this complication and emphasize the importance of identifying potential causes to mitigate the risk of TASS. 

Private ophthalmology clinic in Madrid, Clínica Martínez de Carneros. The cases were managed by the clinic's cataract and refractive surgery team, with close monitoring of anterior segment, funduscopy, and echography of both patients.

Two patients, a 57-year-old man undergoing cataract surgery and a 32-year-old woman receiving an implantable collamer lens (ICL), developed TASS postoperatively. Surgeries were performed in the same operating theatre by same surgeon.

Both patients presented with acute anterior segment inflammation of early onset (12-24 hours) and painless, reduced visual acuity. No systemic diseases or allergies were identified. Medical treatment was promptly initiated with topical dexamethasone and antibiotic drops, resulting in remarkable recovery. Serial imaging was performed to document their clinical progression. ICL extraction was ruled out due to the excellent recovery with topical treatment and the low suspicion of endophthalmitis.

A thorough review of the surgical process was conducted to determine the etiology, with incorrect dilution of the intraoperative antibiotic identified as the most likely cause. 

These cases highlight the need for meticulous attention to intraoperative drug preparation to diminish the risk of TASS. Additionally, we emphasize the value of promptly sharing such cases with colleagues, as it can aid in identifying the etiology and recognizing potential sources of error in the surgical setting.