Development of Toxic Anterior Segment Syndrome Immediately after Uneventful Phaco Surgery

PURPOSE: We report on 15 cases of suspected toxic anterior segment syndrome after uneventful phaco surgery. METHODS: We retrospectively reviewed the charts of patients who had developed toxic anterior segment syndrome (TASS) after uneventful phacoemulsification for senile cataracts between April and December of 2005. Clinical features and all possible causes were investigated including irrigating solutions or drugs, surgical instruments or intraocular lenses, sterilization techniques for instruments, or any other accompanying disease. RESULTS: The patients consisted of 2 males and 13 females with an average age of 64.7+/-10.9 years. Five different surgeons had performed their phaco surgeries. No abnormal preoperative or operative findings were reported. Nevertheless, all 15 patients developed a moderate degree of corneal edema. Ordinary treatments were not helpful. We suspect that lack of sterilization resulted in the development of the syndrome, because after ethylene oxide gas sterilization was replaced with autoclaving, no such incidents have occurred. CONCLUSIONS: Toxic anterior segment syndrome requires special attention and thorough management, including sterilization of reused surgical instruments.