Doctors should be on alert for changes in protocol to avoid cases of TASS

KOLOA, Hawaii — The incidence of toxic anterior segment syndrome is low — estimated at around 0.1% to 2% — but "it appears to be growing," according to surgeon speaking here.

In light of this, Terry Kim, MD, said the surgeon is the key to recognizing the problem immediately and alerting the appropriate staff or other centers to take swift action. Toxic anterior segment syndrome (TASS) occurs in clusters or outbreaks, so it could indicate that something has changed in the office setting that might be provoking it.

"You may have some change in your sterilization protocol that you might not even be aware of," Dr. Kim said at Saturday Subspecialty Day, preceding the Hawaiian Eye 2007 meeting here. "It is certainly an environmental and toxic control issue and it does require an investigation and a complete analysis," he said.

He urged surgeons to pay close attention to any medication they inject into the anterior chamber and to be attuned to any changes in operating and sterilization protocol.

"But you are they key in identifying any epidemic of TASS, because you'll be seeing these patients postoperatively," Dr. Kim said.

Surgeons should take prophylactic measures to insure that TASS and other infections do not enter the eye perio- or postoperatively.

Alternative ways to seal wounds to help bacteria and organisms from entering the eye are also becoming available, Dr. Kim said. A new liquid sealant called OcuSeal, a synthetic hydrogel bandage developed by Hyperbranch, is designed for direct application on the ocular surface to protect the wound.

"This might indicate a paradigm shift, moving away from sutures to alternative modes for sealing wounds," he said.