Delayed-Onset Toxic Anterior Segment Syndrome Combined With Herpes Simplex Keratitis After Cataract Surgery

Area of Science:

• Ophthalmology
• Medical Case Reports

Background:

• Delayed-onset inflammation after cataract surgery can present diagnostic challenges.
• Toxic Anterior Segment Syndrome (TASS) and Herpes Simplex Keratitis (HSK) are distinct ocular conditions that can affect visual outcomes.
• Differentiating these conditions from infectious endophthalmitis is critical for appropriate management.

Purpose of the Study:

• To report a rare case of simultaneous delayed-onset TASS and HSK following cataract surgery.
• To explore effective diagnosis and treatment strategies for this complex presentation.
• To emphasize the importance of considering multiple etiologies in post-cataract surgery inflammation.

Main Methods:

• Retrospective analysis of a 78-year-old female patient presenting 17 days post-cataract surgery with visual loss and anterior segment inflammation.
• Ocular examination revealed corneal epithelial defect, anterior chamber exudates, and intraocular lens surface exudate.
• Aqueous humor analysis was performed to rule out infectious endophthalmitis, followed by systemic and topical antiviral, anti-inflammatory, and corneal nutritional treatments.

Main Results:

• Aqueous humor pathogen detection did not support infectious endophthalmitis.
• The patient's symptoms gradually improved with treatment, including corneal healing and absorption of exudates.
• Visual acuity in the affected eye recovered to 0.5 (20/40) by 23 days post-discharge.

Conclusions:

• Delayed-onset inflammation post-cataract surgery necessitates vigilance for coexisting multiple causes.
• Excluding infectious endophthalmitis is the crucial first step in diagnosis.
• Combined antiviral and anti-inflammatory treatment, after ruling out infection, can lead to a favorable prognosis.