2. DR ALI SALEHI

3. TOXIC ANTERIOR SEGMENT SYNDROM (TASS)

4. TASS Sterile postoperative inflammatory reaction caused by a noninfectious substance that enters the anterior segment resulting in toxic damage to intraocular tissues. (mason et al in1992)

5. TASS The pathologic changes are limited to the anterior chamber.

6. TASS is an acute inflammation of anterior segment of the eye following cataract surgery. A variety of substances have been implicated as causes of TASS.

7. 1)Extraocular substances a) Topical anti-septic agents b) Talc from surgical gloves c) Topical ophthalmic ointment 2) Products that are introduced into the anterior chamber as a part of the surgical procedure a) Anesthetic agents b) Preservatives c) IOL d) drugs

8. TASS The symptoms and signs of TASS may mimic those of infectious endophthalmitis and include: pain, photophobia, severe reduction in visual acuity, marked anterior chamber reaction occasionally with hypopyon.

9. TASS presents within 12-24 hours whereas acute infectious endophthalmitis typically develops 2-7 days after surgery.

10. TASS Other potentially distinguishing features of TASS include 1.diffuse, limbus-to- limbus corneal edema; 2. anterior chamber opacification 3) a dilated, irregular or nonreactive pupil 4) and elevated lOP.

11. TASS Skin cleansers containing chlorhexidine gluconate (eg, Hibiclens) have been reported to cause irreversible corneal edema and opacification if they come into contact with the endothelial surface.

12. TASS Preservatives present in prediluted epinephrine (I: I0,000) added to irrigating solutions have been implicated in corneal decompensation. Unpreserved I: 1000 epinephrine is preferred.. Substitution of sterile water for balanced salt solution,

13. Treatment consists of intensive topical corticosteroids until the inflammation subsides. A brief course of systemic corticosteroids may be beneficial. Frequent follow-up is necessary to monitor lOP and to reassess for signs of bacterial infection.

14. Infectious endophthalmitis caused by bacteria and fungi is often difficult to distinguish from other types of intraocular inflammation.

15. TASS Excessive inflammation without endophthalmitis is often encountered postoperatively in the setting of 1. complicated surgery, preexisting uveitis 2.keratitis, 3. diabetes, 4.glaucoma therapy, and 5.previous surgery

16. TASS The most helpful distinguishing characteristic of true infectious endophthalmitis is that the vitritis is progressive and out of proportion to other anterior segment findings. When in doubt, the clinician should manage the condition as an infectious process

17. THE END