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Delaware Health Alert Network #115

May 5, 2006 1:49 PM


Health Advisory
TOXIC ANTERIOR SEGMENT SYNDROME

Delaware Division of Public Health (DPH) is providing the following information to the medical community concerning the importance of reporting suspect or confirmed cases of Toxic Anterior Segment Syndrome (TASS) to DPH.

No cases of TASS have been reported to DPH at this time.

CDC is investigating an apparent nationwide increase in this condition, which sometimes occurs following cataract surgery. As of this time the cause of this increase in cases has not been identified.

Clinical Information

TASS is a sterile postoperative inflammatory reaction caused by a noninfectious substance that enters the anterior segment, resulting in toxic damage to intraocular tissues. The process typically starts 12 to 48 hours after cataract/anterior segment surgery, is limited to the anterior segment of the eye, is always Gram stain and culture negative, and usually improves with steroid treatment. The primary differential diagnosis is infectious endophthalmitis. Review of the literature indicates that possible causes of TASS include intraocular solutions with inappropriate chemical composition, concentration, pH, or osmolality; preservatives; denatured ophthalmic viscosurgical devices; enzymatic detergents; bacterial endotoxin; oxidized metal deposits and residues; and factors related to intraocular lenses such as residues from polishing or sterilizing compounds. An outbreak of TASS is an environmental and toxic control issue that requires complete analysis of all medications and fluids used during surgery, as well as complete review of operating room and sterilization protocols.

Reporting

CDC sent a request for information on TASS to ophthalmic surgeons through their professional organizations and associations. However, DPH is asking that medical personnel notify DPH of any suspect or confirmed case. DPH will then notify the appropriate personnel at the Centers for Disease Prevention and Control . Contact DPH, Epidemiology at 1-888-295-5156 to report such cases.

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