Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime

Burçin Çakır, Erkan Celik, Nilgün Özkan Aksoy, Özlem Bursalı, Turgay Uçak, Erdinç Bozkurt, Gursoy Alagoz, Burçin Çakır, Erkan Celik, Nilgün Özkan Aksoy, Özlem Bursalı, Turgay Uçak, Erdinç Bozkurt, Gursoy Alagoz

Abstract

Purpose: To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime.

Methods: We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS.

Results: The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed.

Conclusion: All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.

Keywords: drug toxicity; fibrin reaction; phacoemulsification.

Figures

Figure 1
Figure 1
Fibrin reaction extended as far as paracentesis.
Figure 2
Figure 2
Hypopyon formation.

References

    1. Sorkin N, Varssano D. Toxic anterior segment syndrome following a triple Descemet’s stripping automated endothelial keratoplasty procedure. Case Rep Ophthalmol. 2012;3(3):406–409.
    1. Van Philips LA. Toxic anterior segment syndrome after foldable artiflex iris-fixated phakic intraocular lens implantation. J Ophthalmol. 2011;2011:982410.
    1. Sato T, Emi K, Ikeda T, et al. Severe intraocular inflammation after intravitreal injection of bevacizumab. Ophthalmology. 2010;117(3):512–516.
    1. Cutler Peck CM, Brubaker J, Clouser S, Danford C, Edelhauser HE, Mamalis N. Toxic anterior segment syndrome: common causes. J Cataract Refract Surg. 2010;36(7):1073–1080.
    1. Sarobe Carricas M, Segrelles Bellmunt G, Jiménez Lasanta L, Iruin Sanz A. Toxic anterior segment syndrome (TASS): studying an outbreak. Farm Hosp. 2008;32(6):339–343.
    1. Kutty PK, Forster TS, Wood-Koob C, et al. Multistate outbreak of toxic anterior segment syndrome, 2005. J Cataract Refract Surg. 2008;34(4):585–590.
    1. Unal M, Yücel I, Akar Y, Oner A, Altin M. Outbreak of toxic anterior segment syndrome associated with glutaraldehyde after cataract surgery. J Cataract Refract Surg. 2006;32(10):1696–1701.
    1. Hellinger WC, Hasan SA, Bacalis LP, et al. Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture. Infect Control Hosp Epidemiol. 2006;27(3):294–298.
    1. Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, ESCRS Endophthalmitis Study Group ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32(3):407–410.
    1. Jiang J, Wu M, Shen T. The toxic effect of different concentrations of povidone iodine on the rabbit’s cornea. Cutan Ocul Toxicol. 2009;28(3):119–124.
    1. Bodnar Z, Clouser S, Mamalis N. Toxic anterior segment syndrome: update on the most common causes. J Cataract Refract Surg. 2012;38(11):1902–1910.
    1. Buchen SY, Calogero D, Hilmantel G, Eydelman MB. Rabbit ocular reactivity to bacterial endotoxin contained in aqueous solution and ophthalmic viscosurgical devices. Ophthalmology. 2012;119(7):e4–e10.
    1. Barry P. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study. J Cataract Refract Surg. 2014;40(1):138–142.
    1. Lockington D, Flowers H, Young D, Yorston D. Assessing the accuracy of intracameral antibiotic preparation for use in cataract surgery. J Cataract Refract Surg. 2010;36(2):286–289.
    1. Yoeruek E, Spitzer MS, Saygili O, et al. Comparison of in vitro safety profiles of vancomycin and cefuroxime on human corneal endothelial cells for intracameral use. J Cataract Refract Surg. 2008;34(12):2139–2145.
    1. Lockington D, Macdonald EC, Young D, Stewart P, Caslake M, Ramaesh K. Presence of free radicals in intracameral agents commonly used during cataract surgery. Br J Ophthalmol. 2010;94(12):1674–1677.
    1. Lam PT, Young AL, Cheng LL, Tam PM, Lee VY. Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery. Clin Ophthalmol. 2010;8(4):1499–1504.
    1. Montan PG, Wejde G, Setterquist H, Rylander M, Zetterström C. Prophylactic intracameral cefuroxime. Evaluation of safety and kinetics in cataract surgery. J Cataract Refract Surg. 2002;28(6):982–987.
    1. Matsuura K, Miyoshi T, Suto C, Akura J, Inoue Y. Efficacy and safety of prophylactic intracameral moxifloxacin injection in Japan. J Cataract Refract Surg. 2013;39(11):1702–1706.
    1. Asena L, Akova YA, Goktaş MT, et al. Ocular pharmacokinetics, safety and efficacy of intracameral moxifloxacin 0.5% solution in a rabbit model. Curr Eye Res. 2013;38(4):472–479.
    1. Ekinci Koktekir B, Aslan BS. Safety of prophylactic intracameral moxifloxacin use in cataract surgery. J Ocul Pharmacol Ther. 2012;28(3):278–282.
    1. Kobayakawa S, Hiratsuka Y, Watabe Y, Murakami A, Tochikubo T. Comparison of the influence of intracameral gentamicin, gatifloxacin, and moxifloxacin on the corneal endothelium in a rabbit model. Jpn J Ophthalmol. 2010;54(5):481–485.
    1. Lane SS, Osher RH, Masket S, Belani S. Evaluation of the safety of prophylactic intracameral moxifloxacin in cataract surgery. J Cataract Refract Surg. 2008;34(9):1451–1459.
    1. Kim SY, Park YH, Lee YC. Comparison of the effect of intracameral moxifloxacin, levofloxacin and cefazolin on rabbit corneal endothelial cells. Clin Experiment Ophthalmol. 2008;36(4):367–370.
    1. Espiritu CR, Caparas VL, Bolinao JG. Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients. J Cataract Refract Surg. 2007;33(1):63–68.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa