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Noninfectious Inflammation in Cataract Surgery

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Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders

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Abstract

Intraocular inflammation following cataract surgery is commonly seen. However, the majority of these cases have a mild transient inflammation. More severe or persistent postoperative inflammation can lead to significant complications such as corneal decompensation, glaucoma, chronic uveitis, and cystoid macular edema. There are multiple causes of anterior segment inflammation following cataract surgery. Primary among these are inflammation secondary to the surgical procedure itself and complications related to the cataract surgery. Toxic anterior segment syndrome or TASS is an acute, sterile postoperative inflammation secondary to a toxic insult in the anterior chamber of the eye following otherwise unremarkable cataract surgery. The most common findings are diffuse, limbus to limbus corneal edema and significant anterior chamber inflammation with hypopyon formation and fibrin. Lastly, iris and pupillary abnormalities can be seen secondary to TASS with subsequent secondary glaucoma. The most common etiologic causes of TASS are problems with instruments, cleaning, and sterilization as well as issues with fluids or medications used intraocularly during surgery. Subacute or chronic postoperative inflammation may occur in cases of delayed-onset TASS. In addition, uveitis-glaucoma-hyphema (UGH) syndrome can also occur secondary to mechanical trauma from sulcus-fixated intraocular lenses. Lens-induced inflammation including phacoantigen uveitis or other lens-induced inflammatory diseases may occur with a delayed onset following cataract surgery. In conclusion, inflammation following cataract surgery is seen very commonly and can range from mild and transient to severe and chronic. It is important to recognize potential sources of postoperative inflammation and to direct therapy to calm the inflammation and to treat the inciting etiological factors. Lastly, it is critical to rule out possible infectious etiologies that can cause increased postoperative inflammation.

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References

  1. Meisler DM. Intraocular inflammation and extracapsular cataract surgery. AAO Focal Points. 1990;7:1–10 (B).

    Google Scholar 

  2. Kim SJ, Flach AJ, Jampol LM. onsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol. 2010;55(2):108–33 (B).

    Google Scholar 

  3. Decroos FC, Afshari NA. Perioperative antibiotics and anti-inflammatory agents in cataract surgery. Curr Opin Ophthalmol. 2008;19(1):22–6 (B).

    Article  PubMed  Google Scholar 

  4. Nelson RM, Cecconi O, Roberts WG, et al. Heparin oligosaccharides bind L- and P-selectin and inhibit acute inflammation. Blood. 1993;82:3253–8 (C).

    CAS  PubMed  Google Scholar 

  5. Kohnen T, Dick B, Hessemer V, Koch DD, Jacobi KW. Effect of heparin in irrigating solution on inflammation following small incision cataract surgery. J Cataract Refract Surg. 1998;24(2):237–43 (C).

    Article  CAS  PubMed  Google Scholar 

  6. Kruger A, Amon M, Formanek CA, Schild G, Kolodjaschna J, Schauersberger J. Effect of heparin in the irrigation solution on postoperative inflammation and cellular reaction on the intraocular lens surface. J Cataract Refract Surg. 2002;28:87–92 (C).

    Article  PubMed  Google Scholar 

  7. Bayramlar H, Keskin UC. Heparin in the irrigation solution during cataract surgery. J Cataract Refract Surg. 2002;28(12):2070–1 (C).

    Article  PubMed  Google Scholar 

  8. Bayramlar H, Totan Y, Borazan M. Heparin in the intraocular irrigating solution in pediatric cataract surgery. J Cataract Refract Surg. 2004;30(10):2163–9 (C).

    Article  PubMed  Google Scholar 

  9. Rumelt S, Stolovich C, Segal ZI, Rehany U. Intraoperative enoxaparin minimizes inflammatory reaction after pediatric cataract surgery. Am J Ophthalmol. 2006;141(3):433–7 (C).

    Article  CAS  PubMed  Google Scholar 

  10. Monson MC, Mamalis N, Olson RJ. Toxic anterior segment inflammation following cataract surgery. J Cataract Refract Surg. 1992;18:184–9 (C).

    Article  CAS  PubMed  Google Scholar 

  11. Peck CM, Brubaker J, Clouser S, Danford C, Edelhauser HF, Mamalis N. Toxic anterior segment syndrome: common causes. J Cataract Refract Surg. 2010;36:1073–80 (B).

    Article  Google Scholar 

  12. Mamalis N, Edelhauser HF, Dawson DG, Chew J, Leboyer RM, Werner L. Toxic anterior segment syndrome. J Cataract Refract Surg. 2006;32:324–33 (B).

    Article  PubMed  Google Scholar 

  13. Mamalis N. Toxic anterior segment syndrome. AAO Focal Points. 2009;10:1–13 (B).

    Google Scholar 

  14. Hellinger WC, Hasan SC, Bacalis LP, et al. Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities of autoclave steam moisture. Infect Control Hosp Epidemiol. 2006;27:294–8 (C).

    Article  PubMed  Google Scholar 

  15. Parikh CH, Sippy BD, Martin DF, Edelhauser HF. Effects of enzymatic sterilization detergents on the corneal endothelium. Arch Ophthalmol. 2002;120:165–72 (C).

    Article  CAS  PubMed  Google Scholar 

  16. Kriesler KR, Martin SS, Young CW, Anderson CW, Mamalis N. Postoperative inflammation following cataract extraction caused by bacterial contamination of the cleaning bath detergent. J Cataract Refract Surg. 1992;18:106–10 (C).

    Article  Google Scholar 

  17. American Society of Cataract and Refractive Surgery, The American Society of Ophthalmic Registered Nurses. Recommended practices for cleaning and sterilizing intraocular surgical instruments. J Cataract Refract Surg. 2007;33:1095–100. Available at http://www.ascrs.org/TASS/upload/TASS_guidelines.pdf. Accessed 31 Jan 2011 (D)

  18. Hull DS, Chemotti MT, Edelhauser HF, et al. Effect of epinephrine on the corneal endothelium. Am J Ophthalmol. 1975;79:245–50 (C).

    CAS  PubMed  Google Scholar 

  19. Liu H, Routley I, Teichmann K. Toxic endothelial cell destruction from intraocular benzalkonium chloride. J Cataract Refract Surg. 2001;27:1746–50 (C).

    Article  CAS  PubMed  Google Scholar 

  20. Parikh CH, Edelhauser HF. Ocular surgical pharmacology: corneal endothelial safety and toxicity. Curr Opin Ophthalmol. 2003;14:178–85 (B).

    Article  CAS  PubMed  Google Scholar 

  21. Kadonosono K, Ito N, Yazama F, et al. Effect of intracameral anesthesia on the corneal endothelium. J Cataract Refract Surg. 1998;24:1377–81 (C).

    Article  CAS  PubMed  Google Scholar 

  22. Kutty PK, Forster TS, Wood-Koob C, Thayer N, Nelson RB, Berke SJ, Pontacolone L, Beardsley TL, Edelhauser HF, Arduino MJ, Mamalis N, Srinivasan A. Multistate outbreak of toxic anterior segment syndrome, 2005. J Cataract Refract Surg. 2008;34:585–90 (B).

    Article  PubMed  Google Scholar 

  23. Gonnering R, Edelhauser HF, Van Horn DL, et al. The pH tolerance of rabbit and human corneal endothelium. Invest Ophthalmol Vis Sci. 1979;18:373–90 (B).

    CAS  PubMed  Google Scholar 

  24. Edelhauser HF, Van Horn DL, Schultz RO, et al. Comparative toxicity of intraocular irrigating solutions on the corneal endothelium. Am J Ophthalmol. 1976;81:473–81 (B).

    CAS  PubMed  Google Scholar 

  25. Werner L, Sher JH, Taylor JR, Mamalis N, Nash WA, Csordas JE, Green G, Maziarz EP, Liu XM. Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery. J Cataract Refract Surg. 2006;32:227–35 (C).

    Article  PubMed  Google Scholar 

  26. Apple DJ, Hansen SO, Richards SC, et al. Anterior Chamber lenses. Part 1: Complications and pathology and a review of designs. J Cataract Refract Surg. 1987;13:157–74 (B).

    Article  CAS  PubMed  Google Scholar 

  27. Doren GS, Stern GA, Driebe WT. Indications for and results of intraocular lens explantation. J Cataract Refract Surg. 1992;18(1):79–85 (B).

    Article  CAS  PubMed  Google Scholar 

  28. Marak Jr GE. Phacoanaphylactic endophthalmitis. Survey Ophthalmol. 1991;36(5):325–39 (B).

    Article  Google Scholar 

  29. Shetler DJ, Chevez-Barrios P, Dubovy S, Rosa RH, Nasreen S, Wilson MW, Pelton RW, Pe’er J. Ophthalmic Pathology and Intraocular tumors. In: Basic Clinical Science Course. 2009–10; 4:112–113. American Academy of Ophthalmology; 2009 (D).

    Google Scholar 

  30. Jehan FS, Mamalis N, Spencer TS, et al. Postoperative sterile endophthalmitis (TASS) associated with the MemoryLens. J Cataract Refract Surg. 2000;26:1773–7 (C).

    Article  CAS  PubMed  Google Scholar 

  31. Fox GM, Joondeph BC, Flynn Jr HW, et al. Delayed-onset pseudophakic endophthalmitis. Am J Ophthalmol. 1991;111:163–73 (C).

    CAS  PubMed  Google Scholar 

  32. Al-Mezaine HS, Al-Assiri A, Al-Rajhi AA. Incidence, clinical features, causative organisms, and visual outcomes of delayed-onset pseudophakic endophthalmitis. Eur J Ophthalmol. 2009;19:804–11 (C).

    PubMed  Google Scholar 

  33. Meisler DM, Mandelbaum S. Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology. 1989;96:54–61 (B).

    Article  CAS  PubMed  Google Scholar 

  34. Abreu JA, Cordovés L. Chronic or saccular endophthalmitis: diagnosis and management. J Cataract Refract Surg. 2001;27:650–1 (C).

    Article  CAS  PubMed  Google Scholar 

  35. Aldave AJ, Stein JD, Deramo VA, et al. Treatment strategies for postoperative Propionibacterium acnes endophthalmitis. Ophthalmology. 1999;106:2395–401 (B).

    Article  CAS  PubMed  Google Scholar 

  36. Clark WL, Kaiser PK, Flynn HW, et al. Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. Ophthalmology. 1999;106:1665–70 (B).

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, John A. Moran Eye Center, University of Utah, 65 Mario Capechhi Dr., Salt Lake City, 84132, UT, USA

    Nick Mamalis MD & Stanley R. Fuller MD

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  1. Nick Mamalis MD
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  2. Stanley R. Fuller MD
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Correspondence to Nick Mamalis MD .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Charité Campus Virchow-Klinikum, Berlin, Germany

    Uwe Pleyer

  2. Division of Ophthalmology, Miguel Hernandez University, Vissum-Instituto Oftalmologico de Alicante, Alicante, Spain

    Jorge L. Alió

  3. Centre of Ocular Inflammation and Infection OCUVAC, Medical University of Vienna Laura Bassi Centre of Expertise, Vienna, Austria

    Talin Barisani-Asenbauer

  4. Department of Ophthalmology, Pitié-Salpêtrière’s University Hospital, Paris, France

    Phuc Le Hoang

  5. Doheny Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Narsing A. Rao

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Mamalis, N., Fuller, S.R. (2014). Noninfectious Inflammation in Cataract Surgery. In: Pleyer, U., Alió, J., Barisani-Asenbauer, T., Le Hoang, P., Rao, N. (eds) Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54350-0_4

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  • DOI: https://doi.org/10.1007/978-3-642-54350-0_4

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54349-4

  • Online ISBN: 978-3-642-54350-0

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