Cases of toxic anterior segment syndrome after primary pterygium surgery

Purpose Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. Methods A case series. Results Four eyes of four patients developed TAS...

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Veröffentlicht in:International ophthalmology 2022-10, Vol.42 (10), p.3229-3235
Hauptverfasser: Karatas Durusoy, Gönül, Gümüş, Gülşah, Öcal, Mevlüt Celal, Kara, Necip
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container_end_page 3235
container_issue 10
container_start_page 3229
container_title International ophthalmology
container_volume 42
creator Karatas Durusoy, Gönül
Gümüş, Gülşah
Öcal, Mevlüt Celal
Kara, Necip
description Purpose Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. Methods A case series. Results Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch & Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. Conclusions This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.
doi_str_mv 10.1007/s10792-022-02325-2
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We aimed to report an outbreak of TASS which occurred following pterygium surgeries. Methods A case series. Results Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch &amp; Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. Conclusions This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.</description><identifier>ISSN: 1573-2630</identifier><identifier>ISSN: 0165-5701</identifier><identifier>EISSN: 1573-2630</identifier><identifier>DOI: 10.1007/s10792-022-02325-2</identifier><identifier>PMID: 35567693</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Acetic acid ; Acuity ; Anterior chamber ; Cornea ; Corneal transplantation ; Edema ; Eye surgery ; Fibrin ; Formaldehyde ; Hyaluronic acid ; Inflammation ; Medicine ; Medicine &amp; Public Health ; Moxifloxacin ; Ophthalmology ; Original Paper ; Pain ; Patients ; Prednisolone ; Segments ; Surgery ; Visual acuity</subject><ispartof>International ophthalmology, 2022-10, Vol.42 (10), p.3229-3235</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Nature B.V.</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-d8069540bccd6f0e54258de695f047fe77eba14abe262154ea4c08a2a105b813</citedby><cites>FETCH-LOGICAL-c375t-d8069540bccd6f0e54258de695f047fe77eba14abe262154ea4c08a2a105b813</cites><orcidid>0000-0001-7768-9430</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10792-022-02325-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10792-022-02325-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35567693$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karatas Durusoy, Gönül</creatorcontrib><creatorcontrib>Gümüş, Gülşah</creatorcontrib><creatorcontrib>Öcal, Mevlüt Celal</creatorcontrib><creatorcontrib>Kara, Necip</creatorcontrib><title>Cases of toxic anterior segment syndrome after primary pterygium surgery</title><title>International ophthalmology</title><addtitle>Int Ophthalmol</addtitle><addtitle>Int Ophthalmol</addtitle><description>Purpose Toxic anterior segment syndrome (TASS) is an acute, sterile, inflammatory reaction of the anterior segment after intraocular surgeries. We aimed to report an outbreak of TASS which occurred following pterygium surgeries. Methods A case series. Results Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch &amp; Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. Conclusions This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.</description><subject>Acetic acid</subject><subject>Acuity</subject><subject>Anterior chamber</subject><subject>Cornea</subject><subject>Corneal transplantation</subject><subject>Edema</subject><subject>Eye surgery</subject><subject>Fibrin</subject><subject>Formaldehyde</subject><subject>Hyaluronic acid</subject><subject>Inflammation</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Moxifloxacin</subject><subject>Ophthalmology</subject><subject>Original Paper</subject><subject>Pain</subject><subject>Patients</subject><subject>Prednisolone</subject><subject>Segments</subject><subject>Surgery</subject><subject>Visual acuity</subject><issn>1573-2630</issn><issn>0165-5701</issn><issn>1573-2630</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1PwzAMhiMEYmPwBzigSFy4FJykSdojmoAhTeKye5S27tRpbUbSSuzfk33wIQ4crNjx6zfxQ8g1g3sGoB8CA53zBPguBJcJPyFjJrVIuBJw-isfkYsQVgCQ61ydk5GQUmmVizGZTW3AQF1Ne_fRlNR2PfrGeRpw2WLX07DtKu9apLaOHbrxTWv9lm5isV02Q0vD4JcxvyRntV0HvDqeE7J4flpMZ8n87eV1-jhPSqFln1QZqFymUJRlpWpAmXKZVRjvakh1jVpjYVlqC-SKM5miTUvILLcMZJExMSF3B9uNd-8Dht60TShxvbYduiEYrlSqcwYqi9LbP9KVG3wXP2e4ZjoykHtDflCV3oXgsTbHFQ0Ds8NsDphNxGz2mA2PQzdH66Fosfoe-eIaBeIgCLHVRT4_b_9j-wmStIfP</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Karatas Durusoy, Gönül</creator><creator>Gümüş, Gülşah</creator><creator>Öcal, Mevlüt Celal</creator><creator>Kara, Necip</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7768-9430</orcidid></search><sort><creationdate>20221001</creationdate><title>Cases of toxic anterior segment syndrome after primary pterygium surgery</title><author>Karatas Durusoy, Gönül ; 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We aimed to report an outbreak of TASS which occurred following pterygium surgeries. Methods A case series. Results Four eyes of four patients developed TASS associated with formaldehyde after uneventful primary pterygium surgery with conjunctival autograft. No patients reported pain; all patients demonstrated diffuse corneal edema, epithelial defects, and anterior chamber inflammation without hypopyon, fibrin formation, and vitreous involvement on the first postoperative day. TASS diagnosis was made based on clinical findings. All patients were treated with hourly topical 1% prednisolone acetate (Pred Forte, Allergan, CA), moxifloxacin 0.5% (Vigamox, Alcon, TX), and 0.24% of hyaluronic acid (Artelac complete, Bausch &amp; Lomb). Oral steroid (prednisolone 1 mg/kg) was added on the first week and gradually tapered over weeks. None of the affected corneas improved spontaneously. Best-corrected visual acuity ranged from 20/25000 to 20/200 in the second month after surgery. Keratoplasty was scheduled for all patients. Conclusions This is the first study to present TASS cases after pterygium surgery. Clinicians should be aware of TASS that can emerge after an extraocular surgery. In our analysis, since 2% formaldehyde was used by the operating room personnel for cleaning and sterilizing reusable ocular instruments, it was thought that formaldehyde was the most likely cause.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>35567693</pmid><doi>10.1007/s10792-022-02325-2</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7768-9430</orcidid></addata></record>
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subjects Acetic acid
Acuity
Anterior chamber
Cornea
Corneal transplantation
Edema
Eye surgery
Fibrin
Formaldehyde
Hyaluronic acid
Inflammation
Medicine
Medicine & Public Health
Moxifloxacin
Ophthalmology
Original Paper
Pain
Patients
Prednisolone
Segments
Surgery
Visual acuity
title Cases of toxic anterior segment syndrome after primary pterygium surgery
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