Toxic anterior segment syndrome following deep anterior lamellar keratoplasty

Abstract

We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS) that developed after undergoing deep anterior lamellar keratoplasty (DALK). She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA) was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber. Keywords

Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report

“…Toxic anterior segment syndrome (TASS) is an acute and noninfectious inflammation of the anterior segment [6] . Depending on the severity of inflammation, other symptoms may be present, such as pain, conjunctival injection or chemosis, hypopyon, corneal edema, keratic precipitates, anterior vitreous opacities and visual deterioration [7] , or can course uneventful, with no apparent reaction [8] .…”

Early Complications With Preloaded Descemet Membrane Endothelial Keratoplasty Are Not Dependent on Optisol-GS Washout or Trypan Blue Restaining

“…7 TASS has rarely been reported in the setting of corneal transplantation. 8,9 Gentamycin and streptomycin are potentially toxic, but their concentrations in Optisol-GS have confirmed endothelial safety in vitro. 10 Dextran is another component that could cause anterior chamber toxicity and if trapped in the interface could promote graft detachments.…”

Toxic Anterior Segment Syndrome After an Uncomplicated Vitrectomy With Epiretinal Membrane Peeling

“…Toxic anterior segment syndrome (TASS) is defined as a sterile postoperative inflammation of the anterior segment after intraocular surgery [2]. TASS is usually reported after cataract surgery, however, single studies on TASS after keratoplasty or posterior segment surgeries have been published [3][4][5]. In large case series involving over 10,000 cataract surgeries, the incidence of TASS was 0.1-0.22% [6][7][8].…”