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Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update
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Minute amounts of foreign substances may incite inflammation, and the large number and variety of surgical instruments used, as well as their different sterilization processes, make prevention challenging. Proper cleaning of surgical instruments and sterilization remain important for reducing rates of TASS (102). When povidone-iodine cannot be used for cataract surgery (although true allergy is rare), the use of topical chlorhexidine gluconate may be considered, although this agent may be toxic to the cornea (20,32).
Toxic Anterior Segment Syndrome (TASS) is a rare and devastating complication of intraocular surgery. TASS is an acute sterile anterior chamber inflammatory reaction that usually develops hours after anterior segment surgery. Late-onset TASS has also been reported. The condition is responsive to topical steroids in most cases. Risk factors for endophthalmitis include preoperative, intraoperative, and postoperative factors. Preoperative factors include uncontrolled blepharitis or other ocular surface disease, diabetes mellitus, an immunocompromised state, infectious foci near the surgical site, and advanced age (5,10-12).
The posterior pole may be difficult to view if there is severe anterior chamber reaction. In these situations, the patient should have an ultrasound B-scan to rule out any posterior reaction. Both aqueous and vitreous taps are sent for culture to investigate for an infectious process. Although the pathophysiology remains elusive, TASS typically represents an inflammatory response to a noninfectious substance introduced into the eye during surgery.