Toxic Anterior Segment Syndrome: A 2012-2022 Update on the Most Common Causes

Area of Science:

• Ophthalmology
• Surgical Safety
• Medical Device Sterilization

Background:

• Toxic anterior segment syndrome (TASS) is a serious postoperative complication following cataract surgery.
• Identifying causative factors is crucial for preventing TASS outbreaks and improving patient outcomes.

Purpose of the Study:

• To analyze trends in reported toxic anterior segment syndrome (TASS) cases submitted to the American Society of Cataract and Refractive Surgery (ASCRS) TASS Force.
• To identify common surgical practices associated with TASS outbreaks between 2012 and 2022.

Main Methods:

• Retrospective analysis of 77 TASS questionnaires from surgical centers reporting TASS cases.
• Data collected from January 1, 2012, to December 31, 2022.
• Examined instrument cleaning, sterilization, and product usage during cataract surgery.

Main Results:

• 539 TASS cases reported across 56,319 cataract surgeries.
• Commonly associated practices included reuse of single-use items (69%), enzymatic cleaner use (40%), and inadequate handpiece flushing (27%).
• Other factors: reuse of tubing (22%), preservative-containing anesthetics (18%), and antibiotics in BSS (17%).

Conclusions:

• Surgical practices such as reusing disposable instruments and inadequate cleaning are significantly associated with TASS.
• Analysis revealed key trends in TASS-related practices over a decade.
• Implementing safe alternatives and modifying practices can prevent TASS complications.