The association between toxic anterior segment syndrome and intraocular pressure
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CATARACT
The association between toxic anterior segment syndrome and intraocular pressure Karny Shouchane-Blum 1,2
&
Assaf Gershoni 1,2 & Michael Mimouni 3,4 & Alon Zahavi 1,2 & Ori Segal 1,5 & Noa Geffen 1,2
Received: 20 December 2019 / Revised: 28 July 2020 / Accepted: 30 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate the association between toxic anterior segment syndrome (TASS) and intraocular pressure (IOP). Methods This is a retrospective, controlled, single-site study. Patients who developed TASS following a clear corneal incision cataract surgery in Rabin Medical Center (Petah Tikva, Israel), between the years 2010–2018, were enrolled. The primary outcome was IOP measured 1, 7 (± 2), and 30 (± 7) days after surgery. The need for ocular hypotensive treatment was the secondary outcome. Results The study and control groups included 374 and 127 eyes, respectively. The mean IOP in the study and the control groups were 16.3 ± 7.1 and 15.3 ± 3.0 (p = 0.02) at day 1, 13.2 ± 5.0 and 13.7 ± 2.9 (p = 0.18) at day 7, and 13.7 ± 4.1 and 13.5 ± 2.8 (p = 0.65) at day 30. Prevalence of high IOP (> 21 mmHg) was significantly higher in the study group solely on the first postoperative day (12.7% and 3.2%, p = 0.002). In the study group, 9%, 3.7%, and 1.6% of the patients required hypotensive medications at day 1, 7, and 30, respectively. Four patients (~ 1%) in the study group developed acute angle closure due to pupillary block, 1– 3 weeks after surgery and required laser iridotomy and topical treatment. Conclusion High IOP is considered a concerning characteristic of the late stages of TASS although such association lack supporting evidence. This study did not detect such an association. High IOP was found only in a small group of TASS patients in the early perioperative period.
Keywords TASS . Toxic anterior segment syndrome . IOP . Intraocular pressure . Glaucoma . Cataract
Introduction
* Karny Shouchane-Blum [email protected] 1
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
2
Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
3
Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
4
The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
5
Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
Toxic anterior segment syndrome (TASS) is a sterile inflammation developed after ocular surgery, mostly cataract surgery. According to the literature, TASS is usually characterized by an acute presentation beginning 12–48 h after surgery, though the onset may also be delayed [1]. Anterior chamber inflammatory response in the form of cells, flare, and fibrin formation are the most common signs of TASS (Fig. 1). It may also be characterized by conjunctival injection or chemosis, limbus-to-limbus corneal edema, hypopyon, anterior and posterior synechiae formation, and an irregular pupil [2–5]. The presentation can be mild with a minimal cellular
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