Toxic anterior segment syndrome: Update on the most common causes

J Cataract Refract Surg. 2012 Nov;38(11):1902-10. doi: 10.1016/j.jcrs.2012.06.053. Epub 2012 Sep 19.


Purpose: To determine how the most common risk factors for toxic anterior segment syndrome (TASS) have evolved over the past decade.

Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

Design: Cross-sectional study.

Methods: This was a retrospective analysis of surveys from centers reporting cases of TASS from June 1, 2007, through March 1, 2012, and information from visits to afflicted sites between October 1, 2005, and December 31, 2011. Results from June 1, 2009, to March 1, 2012, were compared with those collected before June 1, 2009.

Results: The data from 130 questionnaires and 71 site visits were analyzed. The reporting centers performed approximately 69 000 surgeries and reported 1454 cases of TASS. Several trends were noted when comparing the most recent data with previously reported results. There was a 26% reduction in sites reporting inadequate handpiece flushing volumes and a 27% increase in sites using a deionized/distilled final rinse. At sites visited, there was a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents. However, there was a 21% increase in handling of intraocular lenses or instrument tips with gloved hands, a 47% increase in poor instrument maintenance, and a 34% increase in ultrasound bath use without adequate routine cleaning.

Conclusions: Education may have improved some instrument-cleaning and perioperative practices that increase the risk for TASS; however, other practices may be headed in an unfavorable direction.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anterior Eye Segment / pathology*
  • Cataract Extraction*
  • Cross-Sectional Studies
  • Eye Diseases / epidemiology*
  • Eye Diseases / etiology
  • Health Surveys
  • Humans
  • Postoperative Complications*
  • Retrospective Studies
  • Risk Factors
  • Shock, Septic / epidemiology*
  • Shock, Septic / etiology
  • Surveys and Questionnaires
  • United States / epidemiology