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The association between toxic anterior segment syndrome and intraocular pressure

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Abstract

Purpose

To investigate the association between toxic anterior segment syndrome (TASS) and intraocular pressure (IOP).

Methods

This is a retrospective, controlled, single-site study. Patients who developed TASS following a clear corneal incision cataract surgery in Rabin Medical Center (Petah Tikva, Israel), between the years 2010–2018, were enrolled. The primary outcome was IOP measured 1, 7 (± 2), and 30 (± 7) days after surgery. The need for ocular hypotensive treatment was the secondary outcome.

Results

The study and control groups included 374 and 127 eyes, respectively. The mean IOP in the study and the control groups were 16.3 ± 7.1 and 15.3 ± 3.0 (p = 0.02) at day 1, 13.2 ± 5.0 and 13.7 ± 2.9 (p = 0.18) at day 7, and 13.7 ± 4.1 and 13.5 ± 2.8 (p = 0.65) at day 30. Prevalence of high IOP (> 21 mmHg) was significantly higher in the study group solely on the first postoperative day (12.7% and 3.2%, p = 0.002). In the study group, 9%, 3.7%, and 1.6% of the patients required hypotensive medications at day 1, 7, and 30, respectively. Four patients (~ 1%) in the study group developed acute angle closure due to pupillary block, 1–3 weeks after surgery and required laser iridotomy and topical treatment.

Conclusion

High IOP is considered a concerning characteristic of the late stages of TASS although such association lack supporting evidence. This study did not detect such an association. High IOP was found only in a small group of TASS patients in the early perioperative period.

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References

  1. Suzuki T, Ohashi Y, Oshika T, Goto H, Hirakata A, Fukushita K, Miyata K, Japanese Ophthalmological Society HOYA Intraocular Lens–Related Endophthalmitis Investigation Commission (2015) Outbreak of late-onset toxic anterior segment syndrome after implantation of one-piece intraocular lenses. Am J Ophthalmol 159:934–939.e2

    Article  Google Scholar 

  2. Shouchane-Blum K, Dotan A, Bahar I (2019) The evolution of toxic anterior segment syndrome. Curr Opin Ophthalmol 30:50–55

    Article  Google Scholar 

  3. Mamalis N (2010) Toxic anterior segment syndrome update. J Cataract Refract Surg 36:1067–1068

    Article  Google Scholar 

  4. Holland SP, Morck DW, Lee TL (2007) Update on toxic anterior segment syndrome. Curr Opin Ophthalmol 8:4–8

    Article  Google Scholar 

  5. Sengupta S, Chang DF, Gandhi R, Kenia H, Venkatesh R (2011) Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital. J Cataract Refract Surg 37:1673–1678

    Article  Google Scholar 

  6. Mamalis N (2006) Toxic anterior segment syndrome. J Cataract Refract Surg 32:181–182

    Article  Google Scholar 

  7. Monson MC, Mamalis N, Olson RJ (1992) Toxic anterior segment inflammation following cataract surgery. J Cataract Refract Surg 18:184–189

    Article  CAS  Google Scholar 

  8. Singh A, Gupta N, Kumar V, Tandon R (2018) Toxic anterior segment syndrome following phakic posterior chamber IOL: a rarity. BMJ Case Rep 11

  9. Matsou A, Tzamalis A, Chalvatzis N, Mataftsi A, Tsinopoulos I, Brazitikos P (2017) Generic trypan blue as possible cause of a cluster of toxic anterior segment syndrome cases after uneventful cataract surgery. J Cataract Refract Surg 43:848–852

    Article  Google Scholar 

  10. Sevimli N, Karadag R, Cakici O, Bayramlar H, Okumus S, Sari U (2016) Toxic anterior segment syndrome following deep anterior lamellar keratoplasty. Arq Bras Oftalmol 79:330–332

    Article  Google Scholar 

  11. Althomali TA (2016) Viscoelastic substance in prefilled syringe as an etiology of toxic anterior segment syndrome. Cutan Ocul Toxicol 35:237–241

    Article  Google Scholar 

  12. Koban Y, Genc S, Bilgin G, Cagatay HH, Ekinci M, Gecer M, Yazar Z (2014) Toxic anterior segment syndrome following phacoemulsification secondary to overdose of intracameral gentamicin. Case Rep Med 143564

  13. Çakır B, Celik E, Aksoy NÖ, Bursalı Ö, Uçak T, Bozkurt E, Alagoz G (2015) Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime. Clin Ophthalmol Auckl NZ 9:493–497

    Article  Google Scholar 

  14. Bielory BP, Shariff A, Hussain RM, Bermudez-Magner JA, Dubovy SR, Donaldson KE (2017) Toxic anterior segment syndrome: inadvertent administration of intracameral lidocaine 1% and phenylephrine 2.5% preserved with 10% benzalkonium chloride during cataract surgery. Cornea 36:621–624

    Article  Google Scholar 

  15. Dotan A, Kaiserman I, Kremer I, Ehrlich R, Bahar I (2014) Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome. Br J Ophthalmol 98:252–255

    Article  Google Scholar 

  16. Oshika T, Eguchi S, Goto H, Ohashi Y (2017) Outbreak of subacute-onset toxic anterior segment syndrome associated with single-piece acrylic intraocular lenses. Ophthalmology 124:519–523

    Article  Google Scholar 

  17. Sorenson AL, Sorenson RL, Evans DJ (2016) Toxic anterior segment syndrome caused by autoclave reservoir wall biofilms and their residual toxins. J Cataract Refract Surg 42:1602–1614

    Article  Google Scholar 

  18. Moulick PS, Reddy S, Gurunadh VS, Mohindra VK (2015) Toxic anterior segment syndrome – a sequel of uneventful cataract surgery. Med J Armed Forces India 71:S205–S207

    Article  CAS  Google Scholar 

  19. Park CY, Lee JK, Chuck RS (2018) Toxic anterior segment syndrome-an updated review. BMC Ophthalmol 18:276

    Article  CAS  Google Scholar 

  20. Khor WB, Perera S, Jap A, Ho CL, Hoh ST (2009) Anterior segment imaging in the management of postoperative fibrin pupillary-block glaucoma. J Cataract Refract Surg 35:1307–1312

    Article  Google Scholar 

  21. Yoshino H, Seki M, Ueda J, Yoshino T, Fukuchi T, Abe H (2012) Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report. BMC Ophthalmol 12:3

    Article  CAS  Google Scholar 

  22. Calogero D, Buchen SY, Tarver ME, Hilmantel G, Lucas AD, Eydelman MB (2012) Evaluation of intraocular reactivity to metallic and ethylene oxide contaminants of medical devices in a rabbit model. Ophthalmology 119:e36–e42

    Article  Google Scholar 

  23. Cetinkaya S, Dadaci Z, Aksoy H, Acir NO, Yener HI, Kadioglu E (2014) Toxic anterior-segment syndrome (TASS). Clin Ophthalmol Auckl NZ 8:2065–2069

    Article  Google Scholar 

  24. Ahmed IIK, Kranemann C, Chipman M, Malam F (2002) Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg 28:100–108

    Article  Google Scholar 

  25. Shibasaki H, Kurome H, Hayasaka S, Noda S, Setogawa T (1994) Viscoelastic substance in the anterior chamber elevates intraocular pressure. Ann Ophthalmol 26:10–11

    CAS  PubMed  Google Scholar 

  26. Mastropasqua L, Carpineto P, Ciancaglini M, Falconio G (1998) Intraocular pressure changes after phacoemulsification and foldable silicone lens implantation using Healon GV. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z Augenheilkd 212:318–321

    CAS  Google Scholar 

  27. Olivius E, Thorburn W (1985) Intraocular pressure after cataract surgery with Healon. J - Am Intra-Ocul Implant Soc 11:480–482

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Karny Shouchane-Blum, Assaf Gershoni, Alon Zahavi, Ori Segal & Noa Geffen

  2. Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel

    Karny Shouchane-Blum, Assaf Gershoni, Alon Zahavi & Noa Geffen

  3. Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel

    Michael Mimouni

  4. The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Michael Mimouni

  5. Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel

    Ori Segal

Authors
  1. Karny Shouchane-Blum
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  2. Assaf Gershoni
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  3. Michael Mimouni
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  4. Alon Zahavi
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  5. Ori Segal
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  6. Noa Geffen
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Corresponding author

Correspondence to Karny Shouchane-Blum.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from the institutional research ethics board, and all the data collected in this study was in accordance with the ethical standards of the Rabin Medical Center ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Formal participant consent was waived by our institutional review board due to the retrospective nature of the study.

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Shouchane-Blum, K., Gershoni, A., Mimouni, M. et al. The association between toxic anterior segment syndrome and intraocular pressure. Graefes Arch Clin Exp Ophthalmol 259, 425–430 (2021). https://doi.org/10.1007/s00417-020-04881-8

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  • DOI: https://doi.org/10.1007/s00417-020-04881-8

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