Cluster of TASS Cases After Cataract Surgery
American Journal of Ophthalmology, August 2021
Toxic anterior segment syndrome (TASS) is characterized by acute noninfectious inflammation of the anterior segment. Imamachi et al. reviewed seven cases (four patients) of TASS that occurred shortly after placement of the same type of IOL during cataract surgery. The procedures were performed by three surgeons at two facilities. The author stressed the importance of prompt diagnosis and treatment to preserve vision.
Among 162 eyes that received the Lentis Comfort/LS-313 MF15 IOL from July through November 2020, seven eyes (4.3%) displayed acute inflammation of the anterior chamber including fibrin formation within 15 days of uneventful surgery, which consisted of cataract surgery alone (four eyes) or combined with minimally invasive glaucoma surgery (three eyes). During the same period, TASS did not occur with any other IOL model. The authors believe that this is the first study of TASS associated with the Lentis Comfort/LS-313 MF15 IOL. The seven incidents were reported to the lens manufacturer, who investigated the corresponding lens lots and found no deviations from the standard manufacturing protocol.
One patient was 60 years old; the others were in their 70s. Treatment of the inflammation and/or secondary angle closure (due to pupillary obstruction) varied by severity. For mild TASS cases, the authors recommend initial treatment of frequent instillation of a topical steroid (four to eight times daily), especially 0.1% dexamethasone. If this fails, a steroid can be injected.
In this series, one eye was treated conservatively with success, one eye required vitreous surgery, and another required Nd:YAG laser fibrin membranotomy. The fibrin membrane was removed in two eyes, and two others had anterior chamber washout. In all cases, the inflammation and angle closure responded to treatment, and there was no recurrence of fibrin or inflammation. However, the authors cautioned that TASS can cause irreversible corneal endothelial damage and other long-term sequelae.
The original article can be found here.