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AAO, ASCRS warn about increased rates of TASS
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A recent increase in the occurrence of toxic anterior segment syndrome following outpatient cataract surgery has prompted both the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery to issue an alert to members, the groups announced.
“Numerous eye centers throughout North America have been reporting an increased incidence in the occurrence of toxic anterior segment syndrome (TASS),” the alert said. The recent increase is similar to those reported in the fall of 2005, but those were related to endotoxin contamination of balanced salt solution products manufactured by Cytosol. After a federal recall of the Cytosol products, the occurrences seemed to subside by the beginning of 2006, according to the alert.
“However, a new outbreak of TASS appears to have started in approximately March of 2006, is ongoing and is unrelated to the Endosol product,” the alert said.
Surgeons should familiarize themselves with the symptoms of TASS, the alert said, which include rapid onset after generally uneventful cataract and anterior segment surgery. Most patients with TASS show symptoms within 24 hours of cataract surgery, the alert said. “Common findings on anterior segment slit lamp examination include increased cell and flare with associated fibrin and possible hypopyon formation,” the alert said.
Other symptoms may include diffuse corneal edema, iris atrophy with papillary abnormalities and increased IOP. Effective treatment includes intense topical corticosteroid dosing, the alert said. Eventual patient outcome is related to the severity of the toxic insult at the time of surgery.
The etiology of the new outbreak is unknown, AAO and ASCRS said. Materials and solutions placed in the patient’s eye during surgery may be the cause, and problems related to cleaning and sterilizing surgical instruments have also been found to be a cause of TASS.
Nick Mamalis, MD, has analyzed TASS outbreaks at John A. Moran Eye Center for the past 15 years, according to the alert. ASCRS is asking surgeons to report suspicious outbreaks to Dr. Mamalis (nick.mamalis@hsc.utah.edu).