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

To identify trends in the reporting of toxic anterior segment syndrome (TASS) to the American Society of Cataract and Refractive Surgery (ASCRS) TASS Force from 2012-2022.

John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.

Cross-sectional study.

TASS questionnaires on instrument cleaning and sterilization, and extraocular and intraocular products used during cataract surgery were available on the American Society of Cataract and Refractive Surgery website. A retrospective analysis of questionnaires submitted by surgical centers reporting cases of TASS was performed between January 1, 2012, and December 31, 2022, to identify commonly held practices that could cause TASS.

Data from 77 questionnaires were analyzed. The reporting centers performed 56,319 cataract surgeries and reported 539 cases of TASS from January 1, 2012, to December 31, 2022. Common practices associated with the TASS outbreaks in the surveys included re-use of single-use cannulas, phacoemulsification, and irrigation/aspiration tips (69%), use of enzymatic cleaners (40%), inadequate flushing of phacoemulsification and irrigation/aspiration handpieces (27%), reuse of phacoemulsification tubing (22%), use of preservative-containing intracameral anesthetic (18%), and addition of antibiotics to balanced salt solution (17%).

The surveys identified commonly held practices associated with TASS while showcasing trends over the past 10 years. Understanding these findings and the safe alternatives will allow surgical center personnel to change their practices as needed to prevent this complication.