inflamation session - All India Ophthalmological Society

INFLAMMATION SESSION301syndrome (TECDS).TASS most commonly occur acutely followinganterior segment surgery of any kind, but it canhave a delayed onset. Inflammation is sterile.Gram stain and culture will always be negative.Signs and symptoms are similar to infectiousendophthalmitis. Common complaints areblurred vision, ocular pain and redness.Materials and MethodsThis was a retrospective study of 5 eyes of 5patients who developed toxic anterior segmentsyndrome following cataract surgery. All thepatients were evaluated for visual outcome andtreatment strategies. All patients underwent clearcorneal phacoemulsification with foldable IOLimplantation under topical anesthesia.Phacoemulsification was done through a 2.8mmclear corneal incision. 5.5mm rhexis was made.After phacoemulsification, 4 out of 5 patientsreceived hydrophilic IOL and one patient hadhydrophobic IOL from AMO. All surgeries weredone by same surgeon on same day. There wereno intraoperative complications. Out of 6 patientswho underwent surgery on the day 5 patientsdeveloped symptoms of TASS.3 patients presented to us within 24 hours and allby 72 hours of surgery (after requesting them tocome for a review). All the patients wereevaluated by checking the visual acuity, IOP bynon contact tonometer, slit lamp examination,fundus evaluation if view was adequate and USGB scan if required were done. AC tap was done in2 patients.All the patients were treated with topical–prednisolone acetate 1% hourly, homatropine2% 3times /day, subconjuctival antibiotics andsteroids. All patients were also given topicalantibiotics. 3 patients were given oral steroidsand 2 patients were given intravitreal antibiotics,vancomycin and amikacin.ResultsMean age was 57.6± 8.2 (SD). 3 patients weremales and 2 females.3 patients left eye and 2patients right eye were affected. Pre operativelyBCVA in all patients were better than 6/36. 3patients (60%) presented within 24 hours ofsurgery. Other 2(40%) patients came within 48 -72 hours after requesting them for a review. 60%of patients had symptoms of pain, redness anddefective vision. 40% (2 patients) had nocomplaints but on examination they also hadonly hand movement vision with anteriorsegment inflammation. 80% of patients hadeither hand movements (HM) or counting fingerclose to face (CFCF)vision at presentation. Onepatient had 6/60 vision at presentation. Slit lampexamination showed 4 + cells in all patients withhypopyon. All except one patient had fibrinreaction. Fundus was not visible in 80 % (4) ofcases. USG B scan was done in 4 patients. 2patients had clear vitreous and 2 had few anteriorvitreous opacities. AC tap was done in 2 cases. Itwas negative for gram staining and KOH.Culture was also negative.At 1 week all patients had vision better than6/24. 3 patients were 6/24, 1 patient had 6/18and 1 patient had 6/12 by 1 week. At one month2 patients had BCVA of 6/6, 2 had 6/9 and onepatient had 6/12. Pain, redness and hypopyonwere completely resolved by 1 week.DiscussionThe typical hall mark of TASS is an inflammatoryprocess that starts within 24 hours of cataractsurgery. It is usually limited to the anteriorsegment. It is always culture and gram stainnegative and improves with steroid treatment.Inflammation is quite severe. Anothercharacteristic finding is diffuse limbus to limbuscorneal edema. This is due to widespreadendothelial cell damage. TASS also can cause irisand trabecular damage. It will result in pupilwhich dilates and constrict poorly. There isdecreased IOP during early postoperative course.Permanent trabecular damage can causesecondary glaucoma later.It is difficult to differentiate TASS from infectiousendophthalmitis. There are a few differentiatingsigns and symptoms. TASS typically occurswithin 24 hours; where as infectiveendophthalmitis will take 4-7 days. TASS almostalways limited to anterior segment. It usuallyimproves with topical and systemic steroids andcommonly present with diffuse corneal edema.Pain is noted in 75% of infectiousendophthalmitis, along with lid edema,conjunctival chemosis, discharge and diffuseocular injection. Hypopyon and fibrin formationwill be seen in both. None is specific enough todiagnose TASS or rule out infectious etiology.