ESCRS - POREF139 - Rare Case Series Of Toxic Anterior Segment Syndrome Following Phakic Iol Implantation : Describing The Spectrum Of Presentation Along With Diagnostic And Therapeutic Considerations

Rare Case Series Of Toxic Anterior Segment Syndrome Following Phakic Iol Implantation : Describing The Spectrum Of Presentation Along With Diagnostic And Therapeutic Considerations

Published 2026 - 44th Congress of the ESCRS

Reference: POREF139 | Type: Free paper | DOI: 10.82333/kf4h-yf08

Authors: Dr Anuradha Kunapuli* ¹ , Dr Sonali Sahoo ² , Dr Anubha Rathi ³ , Dr Sohini Mandal ²

¹Cataract and refractive surgery services ,L V Prasad Eye Institute ,Hyderabad,India, ²Cornea and Anterior segment ,L V Prasad Eye Institute ,Bhubaneshwar,India, ³Cornea and Anterior segment ,L V Prasad Eye Institute ,Hyderabad,India

Purpose

This clinical report describes the sporadic cases of postoperative toxic anterior segment syndrome (TASS) post phakic intraocular lens implantation.Important diagnostic considerations and clinical evaluation pointers are discussed to aid in decision making. It is important to identify and start appropriate therapy in timely manner in TASS to prevent vision threatening sequalae such as toxic endothelial cell damage , corneal decompensation , macular edema, trabecular meshwork damage and glaucoma .The timely assessment of the condition keeping in mind the close differential of post surgical endophthalmitis is of utmost importance .If treated and managed timely ,TASS can be treated with intensive steroids and can be visually rewarding .

Setting

Phakic intraocular lens (P-IOL) implantation is a safe and effective option for moderate to high refractive errors. Toxic Anterior Segment Syndrome (TASS) is a rare, sterile inflammatory reaction following uncomplicated intraocular surgery and is infrequently reported after P-IOL implantation. It presents with anterior segment inflammation ranging from mild cellular reaction to severe corneal edema and hypopyon, with onset occurring within days or, rarely, months after surgery.

Methods

This retrospective clinical study describes the cases which developed TASS post phakic IOL implantation .These cases had sporadic presentation over a period of 2 years .The study is observational in nature and the patients received no additional intervention beyond standard of care. In this descriptive retrospective study the data were collected using an electronic medical record system.

Results

Case series of 6 patients presenting 2 days–3 weeks after phakic IOL implantation for high myopia (2 males, 4 females; all third decade). Implants included RIL V4c (3), IPCL 2.0 (2) and VICOMO (1). One patient had bilateral involvement; others unilateral, with second eye affected in half. All reported painless vision drop; 4 eyes had VA <20/2000, 2 had 20/60. Findings: corneal edema (7 eyes), AC reaction (+2–+4), hypopyon (4), raised IOP (2). Posterior segment was noted to be normal. Managed with intensive topical ± systemic steroids. All regained pre-op BCVA; 4 patients achieved 20/20 by 1 month.

Conclusions

All patients underwent detailed clinical evaluation and imaging, including B-scan ultrasonography to assess posterior segment involvement. Diagnosis of TASS vs endophthalmitis was based on timing of presentation and clinical features such as circumciliary congestion, corneal edema, and anterior chamber reaction. Key factors favoring TASS were painless vision loss, absence of lid edema, and no posterior segment involvement. Although no definite cause was identified, possible idiosyncratic reaction to pilocarpine or retained OVD was considered. Careful evaluation is essential to avoid misdiagnosis.It is important for ophthalmologists to be aware of this noteworthy complication .