Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery

Abstract

Descemet-stripping automated endothelial keratoplasty was safe and effective in eyes with TASS-associated corneal edema, yielding encouraging surgical and visual outcomes.

Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital

“…Buzard et al 16 report 2 cases of corneal endothelial decompensation attributable to the use of generic trypan blue. Finally, Arslan et al 17 report the successful use of Descemet-stripping endothelial keratoplasty to treat 10 sporadic TASS cases referred for corneal decompensation over a 33-month period. However, no study in literature addresses the overall incidence of corneal decompensation or persistent corneal edema in TASS patients.…”

Histologic Findings of Corneal Buttons in Decompensated Corneas With Toxic Anterior Segment Syndrome After Cataract Surgery

“…In early cases where visualization is sufficient for Descemet stripping, DSAEK is to be chosen; however, in delayed and recalcitrant cases where Descemet stripping is impossible, PK is the only surgical option. 2,16,17 In this study, we aim to represent the histologic findings of TASS in patients who underwent PK for recalcitrant corneal edema. To our knowledge, this is the first study in humans that documents the histologic evaluations of corneal buttons belonging to patients with TASS.…”

“…2,14,15 If medical therapy is ineffective for a patient, Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PK) are 2 surgical options. 2,[15][16][17] Distinguishing TASS from early infectious endophthalmitis is critical because of overlapping symptoms and ocular findings, and when in doubt, the patient should be regarded as having infectious endophthalmitis. Unlike TASS, infectious endophthalmitis is characterized by a later presentation (3-7 postoperative days), pain, and vitritis.…”

Toxic Anterior Segment Syndrome after Foldable Artiflex Iris-Fixated Phakic Intraocular Lens Implantation

“…The offending substances include denatured ophthalmic viscosurgical devices (OVDs), preservatives, talc from surgical gloves, topical ophthalmic ointment, inappropriately reconstituted intraocular preparations, altered pH and osmolarity of intraocular fluids, heat stable endotoxins, and detergents [5, 6]. Mild to moderate cases respond well to corticosteroids [3, 4], while severe cases might lead to corneal decompensation, glaucoma, a permanently dilated pupil, and cystoid macular edema [2, 3, 7, 8]. TASS is most commonly reported after cataract surgery and rarely after phakic intraocular lens (pIOL) implantation [1, 9, 10].…”