Table 1.
Summary of 15 recent case reports of toxic anterior segment syndrome
| First Author (ref. no.) | Number of cases | Onset (days after the surgery) | Inciting agents | Clinical presentations | Managements (n) | Visual outcomes (n) |
|---|---|---|---|---|---|---|
| Miyake et al. [19] | 6 | 42–167 | IOL (ISert model 251, Hoya) | Chemosis, Ciliary injection, Decreased BCVA, Corneal edema, Anterior chamber reaction, hypopyon |
Vitretomy and IOL removal (1), Capsule irrigation (2), Medical treatment only (5) |
BCVA 20/100 (1), BCVA ≥20/30 (5) |
| Suzuki et al. [18] | 251 | 38.44 ± 32.29 Range:0–161 | IOL (ISert model 251 and 255, Hoya) | Anterior chamber reaction (99.2%), conjunctival injection (41.4%) Hypopyon (22.7%) Corneal edema (19.1%) Keratic precipitates (27.9%) |
Medical treatment only (142), Surgical intervention: vitrectomy (49), IOL removal (22), chamber irrigation (51) |
BCVA 0.036 ± 0.242 logMAR |
| Sorenson et al. [10] | 10 | 1–7 | Bacterial biofilm contamination of autoclave reservoir | Anterior chamber reaction (10), Hypopyon (3), Corneal edema (1), Anterior vitreous reaction (4) |
Medical treatment only (3), Vitreous tap and intravitreal injection (7) |
No light perception (1), BCVA≥20/30 (9) |
| Ohika et al. [8] | 147 | 13.1 ± 16.4 Range: 1–88 | IOL (Acrysof, Alcon) | Anterior chamber reaction (97.2%), Conjunctival injection (39.8%), Fibrinous inflammation (43.1%) Hypopyon (22.7%) Corneal edema (15.6%) Keratic precipitates (21.6%), Ocular pain (9.5%) |
Medical treatment only (104), Surgical intervention: vitrectomy (21), IOL removal (10), chamber irrigation (33) |
BCVA> 20/40 (143), BCVA≤20/40 (4) |
| Moyle et al. [9] | 11 | 1 | unknown | Corneal edema (11), anterior chamber reaction (10), Inflammatory plaque on IOL (5), hypopyon (3), fibrin reaction (6), mild pain (2) |
Medical treatment only (11) | BCVA = 20/20 (11) |
| Sengupta et al. [7] | 60 | 1 | Balanced salt solution with a low pH of 6.0 (12), OVD (17), unknown (31) | Severe iridocyclitis with varying degree of corneal edema (60) | Medical treatment only (56), Vitreous tap (4) |
BCVA: 0.11 ± 0.1 logMAR, range: 0–0.3 logMAR |
| Matsou et al. [36] | 5 | 1 | Generic trypan blue | Painless blurry vision, corneal edema, anterior chamber reaction, hypopyon and fibrin reaction | Medical treatment only (5) | BCVA: 0.82 ± 0.18 (Snellen acuity) |
| Bielory et al. [14] | 2 | 1 | intracameral lidocaine HCl 1% and phenylephrine 2.5% inadvertently preserved with 10% benzalkonium chloride. | Acute corneal decompensation (3) | Medical treatment only (1), Corneal transplantation for decompensated cornea (2) |
BCVA = 20/20 (1), NA (1) |
| Althomali [38] | 15 | 1–2 | OVD | Corneal edema (15), hypopyon (8) |
Medical treatment only | BCVA: count finger (2) (other retina pathology), BCVA: 20/70 (2), BCVA≥20/50 (11) |
| Koban et al. [16] | 1 | 1 | Inadvertent overdose of intracameral gentamicin | Hyphema, corneal edema, chemosis, hemorrhagic fibrinous reaction, Corneal decompensation |
Penetrating keratoplasty after medical treatment | BCVA: 20/60 |
| Cetinkaya et al. [54] | 5 | 1 | unknown | corneal edema (5), anterior chamber reaction (5), fibrin (3), hypopyon (3), increased intraocular pressure (3) | Penetrating keratoplasty (2) | BCVA: 20/100 (1), BCVA: 20/40 (1), BCVA≥20/30 (3) |
| Ari et al. [27] | 19 (pediatric patients) | 1–2 | Ethylene oxide gas sterilization | Corneal edema, anterior chamber reaction, | Medical treatment only (18), Penetrating keratoplasty (1) |
NA |
| Buzard et al. [15] | 2 | 1 | Generic trypan blue | Cornea edema, anterior chamber reaction, hypopyon | Penetrating keratoplasty (2) | NA |
| Maier et al. [5] | 24 | 1–2 | Contamination of corneal trephine | Graft infiltration, corneal stromal edema | Medical treatment only (24) | NA |
| Choi et al. [28] | 15 | NA | Ethylene oxide gas sterilization | Corneal edema, anterior chamber reaction, conjunctival injection, pupil irregularity, fibrin reaction | Penetrating keratoplasty (5) | BCVA≥20/200 (14), Light perception (1), |
IOL intraocular lens, BCVA best corrected visual acuity, NA not available, n case number