Toxic anterior segment syndrome subsequent to pediatric cataract surgery

The aim of this study was to investigate possible risk factors and treatment outcomes for the development of toxic anterior segment syndrome (TASS) subsequent to pediatric cataract surgery.

Totally 893 eyes of 534 patients who underwent pediatric cataract surgery were evaluated retrospectively from the point of TASS development between 2006 and 2011. TASS was observed in 19 eyes of 13 patients. Properties of surgical materials used for these patients, postoperative symptoms and their initiation time, therapeutic approaches and results were evaluated.

Lens aspiration, posterior capsulotomy and anterior vitrectomy was performed for 480 eyes and TASS developed in 12 eyes. However, TASS was observed in seven eyes of 413 eyes that underwent lens aspiration, posterior capsulotomy, anterior vitrectomy and intraocular lens (IOL) implantation. The factors that may cause TASS were evaluated. Materials used in surgery (intraocular irrigation fluids, viscoelastic materials, intracameral medications etc.) were the same, in all cases. But in all TASS cases, it has been noticed that ethylene oxide-sterilized vitrectomy packs were used for anterior vitrectomy. After the abolition of use of this material, we didn't see new TASS cases. Clinical improvement was achieved by treatment with 0.1% dexamethasone, 0.3% ofloxasin and 5% NaCl in 18 eyes with TASS at mean duration of 6.4 ± 4.7 (range, 2-16) weeks. Penetrating keratoplasty was performed to one eye of a patient with bilateral TASS due to unresponsiveness to medical management.

Use of ethylene oxide-sterilized vitrectomy packs in pediatric cataract surgery is an important risk factor for the development of TASS. Although the majority of the patients with TASS after pediatric cataract surgery recover with medical therapy, a few cases may need penetrating keratoplasty due to irreversible corneal decompensation.