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I.
II.
Case History
a. 78 year old Caucasian Female
b. Blurred vision without pain one day after cataract surgery.
c. Ocular history:
i. Successful cataract surgery OD 2005, without complication
ii. Epiretinal membrane OU
iii. Macular hole OS, with noted distortion to lines since 2004
iv. Routine and uncomplicated cataract removal with intraocular lens
implant (August 2011) for 2+ nuclear sclerosis, 1+ cortical cataract
OS
d. Medical history:
i. Hypertension
ii. Hyperlipidemia
iii. Osteoporosis
iv. Polymyalgia rheumatica
v. Gasteroesophageal reflux disease
vi. Chronic rhinitis
e. Medications
i. Eye medications, started one day pre-op OS:
1. Prednisolone acetate 1% q.i.d.
2. Ofloxacin 0.3% q.i.d
ii. Systemic medications:
1. Hydrochlorothiazide
2. Aspirin
3. Fosamax
4. Nasonex
5. Symbicort
6. Flexeril
7. Calcium with vitamin D
8. Fish Oil
9. Niacin
10. Red Yeast Rice
f. Three similar cases
i. All presented within one week of initial patient
ii. Increased inflammation including hypopyon and/or fibrin.
iii. Presentation one day after cataract surgery
iv. No pain with reduced vision.
Pertinent findings at one day post cataract surgery
a. Uncorrected vision OS: 20/100 no improvement with pinhole
b. Slit lamp OS:
i. 1+ injection
ii. Descemet’s folds
iii. Diffuse microcystic edema
iv. 2+cell/1+ flare in anterior chamber
III.
IV.
V.
VI.
v. Micro-hypopyon
vi. Fibrin into anterior chamber
vii. Centered posterior chamber intraocular lens.
c. No pain or discomfort, only blurred vision.
d. Slit lamp photos
Differential diagnosis
a. Toxic Anterior Segment Syndrome (TASS)
b. Endophthalmitis
Diagnosis and discussion
a. Aim to reduce inflammation
b. Monitor patient closely
i. Response to treatment
ii. Steroid responder
c. Untreated or extensive inflammation may cause further complications
d. Contaminated equipment used in surgery may contribute to multiple cases
e. Suspicion of an outbreak should lead to a thorough review of surgical
systems and procedures.
Treatment, management
a. Durezol q.i.d added to OS regimen
b. Gradual improvement observed with resolution by 3 weeks
c. Surgical center completed a full review of practices and procedures,
changes were made where appropriate
Conclusion
a. The diagnosis of TASS should be carefully considered and closely
monitored
b. Work with the surgeon to manage care
c. Be aware of potential outbreaks and notify surgical staff
d. Follow patient closely for improvement or complications.