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H. Wafapoor, A. M. Eaton; Clinical Presentation and Management of Severe Toxic Anterior Segment Syndrome (TASS). Invest. Ophthalmol. Vis. Sci. 2008;49(13):966. doi: https://doi.org/.
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To describe clinical presentations of eyes diagnosed with severe TASS, and to demonstrate visual outcomes when treated with high dose posterior subtenon (PST) triamcinolone injection.
Retrospective chart review of patients that were diagnosed with TASS during a 6 months period from 03/01/2007 to 06/30/2007. All had 3 months minimum follow up. Severe TASS was defined as eyes with inflammatory response that not only involved the anterior segment but also produced inflammatory vitreous infiltration of varying degree from mild to severe with obscuration of retinal vasculature.
Total of 9 patients (9 eyes) were identified. Patients' age ranged from 51 to 85 years (average74.3), with 7 (78%) female. Patients were referred from 1 day to 4 days post cataract surgery with a presumptive diagnosis of Endophthalmitis. Patients did not have ocular pain; visual acuity at presentation was hand motion in 4 eyes (44%), 20/400 1 eye (11%), 20/200 2 eyes (22%), 20/100 in 1 eye (11%), and 20/80 1 eye (11%). Intraocular pressure ranged from 5 to 27 mmHg. Anterior segment reaction ranged from presence of white cells and fibrin to hypopion, which was present in 5 eyes (56%). Vitreous inflammation was seen in 7 eyes (78%). At the time of presentation all eyes were on frequent topical steroid drops. Eight eyes received 200 mg PST injection, and 1 eye was continued on frequent topical steroid. One eye underwent vitrectomy and intraocular antibiotic injection with negative cultures. Visual acuity at last follow-up was >20/40 in 7 eyes (78%), 2 eyes had visual acuity of 20/80 vision due to epimacular membrane and cystoid macular edema.
Severe TASS which includes vitreous inflammation, following cataract surgery can mimic infectious endophthalmitis. Clinical presentation as described here, close monitoring and prompt treatment with high dose PST triamcinolone can result in resolution of inflammation and help differentiate this disease process.
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