Toxic anterior segment syndrome following EyePCL implantation in a hyperopic patient

Toxic anterior segment syndrome (TASS) is a rare but serious complication of anterior segment surgery characterised by an acute sterile inflammation. The ICL implantation has gained popularity for the correction of moderate and high ametropias in cases where classical keratorefractive procedures are contraindicated.

The purpose of this case report is to present the evolution and management of toxic anterior segment syndrome after EyePCL implantation in a 19 year old hyperopic male patient.

Case report.

The onset of the disease occurred in the first 48h postsurgery with a sudden loss of vision (with a VA of HM at 2m), mild photophobia and burning sensation in the absence of pain, severe inflammatory reaction of the anterior chamber with hypopyon, a Tyndall of 3+, cyclitic membrane and no posterior chamber inflammation. The evolution under antiinflammatory corticoid treatment along with topical antibiotic, mydriatic and hypotensor treatment was favorable with a BCVA of 7/10, resolution of hypopyon and complete detachment of the cyclitic membrane at day 5 postsurgery. A tapering of the corticoid treatment was started along with NAIDS and at one-month follow-up the patient got a 100% recovery of the visual function.

The most important differential diagnosis to rule out is an infectious endophthalmitis. This case demonstrates that early diagnosis and management of TASS is essential in order to preserve the eye function and structures intact. Treated on time the eye can get a 100% recovery with no sequelaes.