1. Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen
Soaked in Ortho-Phthalaldehyde
Guadalupe Cervantes-Coste MD
Victoria Mercado-Banegas MD
Authors have no financial interest
Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez- Bulnes”

2. Toxic Anterior Segment Syndrome
Sterile post-op inflammatory reaction caused
non-infectious substance
TOXIC damage to intraocular tissues
ACUTE…
…after anterior segment
Surgery
hours post-op

3. Etiologies: Clinical Findings: Ocular medications Antiseptics
Preservatives Sterilizing agents
Cleaning agents Talc IOLs
Viscosurgical devices Endotoxins
Clinical Findings:
Descemet´s membrane folds
Anterior segment inflammation
Diffuse, limbus-to-limbus, corneal edema
Widespread endothelial damage
Fibrin deposits
Irregular and unreactive pupil
Ocular hypertension & trabecular damage

4. Clinical Case: Phaco tip and sleeve cleaned
Uneventful phacoemulsification cataract surgery + acrylic IOL
Infinity Alcon, 2.8 mm incision , continuous OZil
CDE: 9
trans-op medication:
Intracameral vacomycin
Phaco tip and sleeve cleaned
Ortho-Phthalaldehyde 2% solution

5. TASS Medical History: Anterior segment: DM II treated with insulin
48 yr woman with metabolic cataracts OU
DM II treated with insulin
BCVA: OU: Count fingers 2 m
Anterior segment:
OU: Cataracts : N+++
posterior sub capsular opacity + (LOCS III)
IOL calculation (immersion ultrasound)
SRK-T formula
power: D

6. Treatment: 1st day post-phaco: moderate ocular pain
conjunctival injection
limbus-to-limbus corneal edema +++ , irregular endothelium
cells +++
fibrin bands in 4 quadrants
mydriatic and a-reflective pupil
IOP 10 mmHg
Treatment:
Transeptal , topical and oral steroids
Topical antibiotic

7. Adding treatment: Ultrasound: normal Pain decreased, blurring
3er day post-phaco:
Ultrasound: normal
Pain decreased, blurring
Anterior segment: no changes
Adding treatment:
Hypotensors , NaCl 0.5%
& vitamin C
13 days post-phaco:
No pain but blurring
Corneal edema in 3 quadrants
Fibrin bands at 360°
Cells +++
Iridocorneal synechiaes

8. Same treatment Decreased pain BCVA: 1/10 Corneal edema in 3 quadrants
20 days post-phaco:
Decreased pain
BCVA: 1/10
Corneal edema in 3 quadrants
Cells ++
Fibrin bands extending to irido-corneal angle
IOP 18 mmHg
Same treatment

9. Anterior capsulotomy (YAG)
22 days post-phaco:
intense ocular pain, headache
and blurring
conjunctival injection
epithelial corneal edema
cells ++
IOP: 38 mmHg
360° angle closure
Unresponsive to treatment
Charbonic anhidrase inhibitors
Beta- blocker
Adrenergic agonist

10. Amhed Valve implant clear cornea, Valve tube in-situ
1st day post-Valve:
clear cornea, Valve tube in-situ
AC: cells IOP: 4 mmHg
optic nerve cup: 7/10
Treatment:
Topical steroids & antibiotics
Lubricants
8–15 days post-Valve:
vision “subjectively” improved
clear cornea
IOP mmHg
fibrin membrane without changes

11. “Corneal decompensation”
22 days post-Valve:
intense pain and blurring
ciliary injection ++
epithelial corneal edema
AC: cells++ IOP: 38 mmHg
360° angle closure
Unresponsive to treatment:
1 month post-Valve:
“blurring” , VA: CF 10 cm
diffuse corneal edema in quadrants
IOP 14 mmHg
Final diagnosis:
“Corneal decompensation”

12. Differential Diagnosis
signs of infectious absent
ultrasound NO disturbance of vitreous
NO response topical prednisolone and non-steroidal
final Visual Acuity NO improvement during follow-up
irregular pupil NOT reactive to light or medication
Conclusions
colorless liquid & best disinfectant cold sterilization
enzymes of detergents deactivated to 140° C or
most autoclaves reach to 130° C
small lumen instruments…
… possibly reservoirs sterilizing solution residue
TASS from sterilizing solutions residue PREVENTABLE
Glutaraldehyde