Toxic anterior segment syndrome after cataract surgery: the implications for nursing

Authors

  • Reginaldo Adalberto Luz Professor da Escola de Enfermagem da Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP
  • Maria Clara Padoveze Prof.ª Dra. no Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo, USP
  • Rafael Queiroz de Souza Professor de Pós-graduação do Centro Universitário São Camilo.
  • Kazuko Uchikawa Graziano Professora Titular do Departamento de Enfermagem Médico-Cirúrgica da Escola de Enfermagem da USP.
  • Tadeu Cvintal Médico Oftalmologista do Instituto de Oftalmologia Tadeu Cvintal.

DOI:

https://doi.org/10.5327/Z1414-4425201500020005

Keywords:

Extração de catarata, Enfermagem perioperatória, Vigilância epidemiológica, Esterilização, Endoftalmite

Abstract

Objective: To describe the characteristics of the toxic anterior segment syndrome (TASS) and its implications for nursing actions. Method: It is a literature review through research in the MEDLINE (Medical Literature Analysis and Retrieval System Online) and LILACS (Latin American and Caribbean Center on Health Sciences Information) databases. Results: TASS is an acute ocular inflammatory reaction after ophthalmic surgeries, mainly cataract surgery. The clinical signs in the first 12 hours after the surgery include corneal edema, presence of cells in the anterior chamber, increased intraocular pressure, and irregular pupil. The main causes are related to noninfectious substances introduced into the patient’s eye by products used during surgery or due to failures in cleaning and sterilization of surgical instruments. Conclusion: The implications for nursing consist of preventive measures, staff training, orienting the patients, and active epidemiological surveillance aimed at the early identification of warning signs of TASS. Keywords: Cataract extraction. Perioperative nursing. Epidemiological surveillance. Sterilization. Endophthalmitis.

References

Choi JS, Shyn KH. Development of toxic anterior segment syndrome immediately after uneventful phaco surgery. Korean J Ophthalmol. 2008;22(4):220-7. DOI: https://doi.org/10.3341/kjo.2008.22.4.220

Unal M, Yucel I, Akar Y, Oner A, Altin M. Outbreak of toxic anterior segment syndrome associated with glutaraldehyde after cataract surgery. J Cataract Refract Surg. 2006;32(10):1696-701. DOI: https://doi.org/10.1016/j.jcrs.2006.05.008

Werner L, Sher JH, Taylor JR, Mamalis N, Nash WA, Csordas JE, et al. Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery. J Cataract Refract Surg. 2006;32(2):227-35. DOI: https://doi.org/10.1016/j.jcrs.2005.12.093

Monson MC, Mamalis N, Olson RJ. Toxic anterior segment inflammation following cataract surgery. J Cataract Refract Surg. 1992;18(2):184-9. DOI: https://doi.org/10.1016/S0886-3350(13)80929-7

Mamalis N. Inflamation. In: Charlton JF. Ophthalmic surgery complications: prevention and management. Michigan: Lippincott; 1995. p. 313-32.

Andonegui J, Jimenez-Lasanta L, Aliseda D, Lameiro F. Outbreak of toxic anterior segment syndrome after vitreous surgery. Arch Soc Esp Oftalmol. 2009;84(8):403-5. DOI: https://doi.org/10.4321/S0365-66912009000800007

Moisseiev E, Barak A. Toxic anterior segment syndrome outbreak after vitrectomy and silicone oil injection. Eur J Ophthalmol. 2012;22(5):803-7. DOI: https://doi.org/10.5301/ejo.5000116

Maier P, Birnbaum F, Bohringer D, Reinhard T. Toxic anterior segment syndrome following penetrating keratoplasty. Arch Ophthalmol. 2008;126(12):1677-81. DOI: https://doi.org/10.1001/archopht.126.12.1677

Shunmugam M, Hugkulstone CE, Wong R, Williamson TH. Consecutive toxic anterior segment syndrome in combined phaco- vitrectomy. Int Ophthalmol. 2013;33(3):289-90. DOI: https://doi.org/10.1007/s10792-012-9691-5

Alves LFA, Kac MJ, Bisol T, Fernandes BF, Eskenazi DT. Síndrome tóxica do segmento anterior. Rev Bras Oftalmol. 2013;72(1):29-33. DOI: https://doi.org/10.1590/S0034-72802013000100007

Hellinger WC, Hasan SA, Bacalis LP, Thornblom DM, Beckmann SC, Blackmore C, et al. Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture. Infect Control Hosp Epidemiol. 2006;27(3):294-8. DOI: https://doi.org/10.1086/501540

Sengupta S, Chang DF, Gandhi R, Kenia H, Venkatesh R. Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital. J Cataract Refract Surg. 2011;37(9):1673-8. DOI: https://doi.org/10.1016/j.jcrs.2011.03.053

Ozcelik ND, Eltutar K, Bilgin B. Toxic anterior segment syndrome after uncomplicated cataract surgery. Eur J Ophthalmol. 2010;20(1):106-14. DOI: https://doi.org/10.1177/112067211002000114

Nizamani NB, Bhutto IA, Talpur KI. Cluster of Urrets-Zavalia syndrome: a sequel of toxic anterior segment syndrome. Br J Ophthalmol. 2013;97(8):976-9. DOI: https://doi.org/10.1136/bjophthalmol-2012-302319

Ari S, Caca I, Sahin A, Cingu AK. Toxic anterior segment syndrome subsequent to pediatric cataract surgery. Cutan Ocul Toxicol. 2012;31(1):53-7. DOI: https://doi.org/10.3109/15569527.2011.613426

Moyle W, Yee RD, Burns JK, Biggins T. Two consecutive clusters of toxic anterior segment syndrome. Optom Vis Sci. 2013;90(1):e11-23. DOI: https://doi.org/10.1097/OPX.0b013e318279e991

Avisar R, Weinberger D. Corneal endothelial morphologic features in toxic anterior segment syndrome. Cornea. 2010;29(3):251-3. DOI: https://doi.org/10.1097/ICO.0b013e3181b11568

Jehan FS, Mamalis N, Spencer TS, Fry LL, Kerstine RS, Olson RJ. Postoperative sterile endophthalmitis (TASS) associated with the memorylens. J Cataract Refract Surg. 2000;26(12):1773-7. DOI: https://doi.org/10.1016/S0886-3350(00)00726-4

Kremer I, Levinger E, Levinger S. Toxic anterior segment syndrome following iris-supported phakic IOL implantation with viscoelastic Multivisc BD. Eur J Ophthalmol. 2010;20(2):451-3. DOI: https://doi.org/10.1177/112067211002000229

Buzard K, Zhang JR, Thumann G, Stripecke R, Sunalp M. Two cases of toxic anterior segment syndrome from generic trypan blue. J Cataract Refract Surg. 2010;36(12):2195-9. DOI: https://doi.org/10.1016/j.jcrs.2010.09.017

Van Philips LA. Toxic anterior segment syndrome after foldable artiflex iris-fixated phakic intraocular lens implantation. J Ophthalmol. 2011;2011:982410. DOI: https://doi.org/10.1155/2011/982410

Huang Y, Dai Y, Wu X, Lan J, Xie L. Toxic anterior segment syndrome after pediatric cataract surgery. J AAPOS. 2010;14(5):444-6. DOI: https://doi.org/10.1016/j.jaapos.2010.06.011

Pineda 2nd R, Jain V, Gupta P, Jakobiec FA. Descemet’s stripping endothelial keratoplasty: an effective treatment for toxic anterior segment syndrome with histopathologic findings. Cornea. 2010;29(6):694-7. DOI: https://doi.org/10.1097/ICO.0b013e3181bd473c

Arslan OS, Unal M, Arici C, Gorgun E, Yenerel M, Cicik E. Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery. J Cataract Refract Surg. 2010;36(6):965-9. DOI: https://doi.org/10.1016/j.jcrs.2009.12.037

Moshirfar M, Whitehead G, Beutler BC, Mamalis N. Toxic anterior segment syndrome after Verisyse iris-supported phakic intraocular lens implantation. J Cataract Refract Surg. 2006;32(7):1233-7. DOI: https://doi.org/10.1016/j.jcrs.2006.03.014

Jun EJ, Chung SK. Toxic anterior segment syndrome after cataract surgery. J Cataract Refract Surg. 2010;36(2):344-6. DOI: https://doi.org/10.1016/j.jcrs.2009.07.052

Kelley M, Srinivasan A, Pelletier A. Toxic Anterior Segment Syndrome After Cataract Surgery — Maine, 2006. MMWR. 2007;56(25):629-30.

Cutler Peck CM, Brubaker J, Clouser S, Danford C, Edelhauser HE, Mamalis N. Toxic anterior segment syndrome: common causes. J Cataract Refract Surg. 2010;36(7):1073-80. DOI: https://doi.org/10.1016/j.jcrs.2010.01.030

Bodnar Z, Clouser S, Mamalis N. Toxic anterior segment syndrome: Update on the most common causes. J Cataract Refract Surg. 2012;38(11):1902-10. DOI: https://doi.org/10.1016/j.jcrs.2012.06.053

Rose V. Keeping our eyes on TASS: our experience in the ambulatory care setting. Am J Infect Control. 2012;40(5):e149-50. DOI: https://doi.org/10.1016/j.ajic.2012.04.266

Kutty PK, Forster TS, Wood-Koob C, Thayer N, Nelson RB, Berke SJ, et al. Multistate outbreak of toxic anterior segment syndrome, 2005. J Cataract Refract Surg. 2008;34(4):585-90. DOI: https://doi.org/10.1016/j.jcrs.2007.11.037

Clouser S. Toxic anterior segment syndrome: how one surgery center recognized and solved its problem. Insight. 2004;29(1):4-7.

Leder HA, Goodkin M, Buchen SY, Calogero D, Hilmantel G, Hitchins VM, et al. An investigation of enzymatic detergents as a potential cause of toxic anterior segment syndrome. Ophthalmology. 2012;119(7):e30-5. DOI: https://doi.org/10.1016/j.ophtha.2012.04.016

Parikh C, Sippy BD, Martin DF, Edelhauser HF. Effects of enzymatic sterilization detergents on the corneal endothelium. Arch Ophthalmol. 2002;120(2):165-72. DOI: https://doi.org/10.1001/archopht.120.2.165

Calogero D, Buchen SY, Tarver ME, Hilmantel G, Lucas AD, Eydelman MB. Evaluation of intraocular reactivity to metallic and ethylene oxide contaminants of medical devices in a rabbit model. Ophthalmology. 2012;119(7):e36-42. DOI: https://doi.org/10.1016/j.ophtha.2012.04.009

Buchen SY, Calogero D, Hilmantel G, Eydelman MB. Rabbit ocular reactivity to bacterial endotoxin contained in aqueous solution and ophthalmic viscosurgical devices. Ophthalmology. 2012;119(7):e4-10. DOI: https://doi.org/10.1016/j.ophtha.2012.04.006

Sakimoto A, Sawa M, Oshida T, Sugaya S, Hirono T, Ishimori A. Minimum endotoxin concentration causing inflammation in the anterior segment of rabbit eyes. Jpn J Ophthalmol. 2009;53(4):425-32. DOI: https://doi.org/10.1007/s10384-009-0683-6

Food and Drug Administration (FDA). Endotoxin testing recommendations for single-use intraocular ophthalmic devices - draft guidance for industry and food and drug administration staff. [cited 2014 Aug 10]. Available from: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm393374.htm

Mathys KC, Cohen KL, Bagnell CR. Identification of unknown intraocular material after cataract surgery: evaluation of a potential cause of toxic anterior segment syndrome. J Cataract Refract Surg. 2008;34(3):465-9. DOI: https://doi.org/10.1016/j.jcrs.2007.10.047

Tamashiro NS, Souza RQ, Goncalves CR, Ikeda TI, Luz RA, Cruz AS, et al. Cytotoxicity of cannulas for ophthalmic surgery after cleaning and sterilization: Evaluation of the use of enzymatic detergent to remove residual ophthalmic viscosurgical device material. J Cataract Refract Surg. 2013;39(6):937-41. DOI: https://doi.org/10.1016/j.jcrs.2012.12.039

Chen KH, Lin SY, Li MJ, Cheng WT. Retained antibiotic ophthalmic ointment on an intraocular lens 34 months after. Am J Ophthalmol. 2005;139(4):743-5. DOI: https://doi.org/10.1016/j.ajo.2004.10.042

Wong JG, Bank A. Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification. J Cataract Refract Surg. 2006;32(5):890-2. DOI: https://doi.org/10.1016/j.jcrs.2006.01.071

Humayun M, Gottlieb CC, Rafuse PE. Intraocular ophthalmic ointment following clear corneal phacoemulsification. J Cataract Refract Surg. 2006;32(12):2135-8. DOI: https://doi.org/10.1016/j.jcrs.2006.08.034

Kim SY, Park YH, Kim HS, Lee YC. Bilateral toxic anterior segment syndrome after cataract surgery. Can J Ophthalmol. 2007;42(3):490-1. DOI: https://doi.org/10.3129/i07-067

Conner RL. Toxic anterior segment syndrome; US Food and Drug Administration product and device clearance. AORN journal. 2006;84(5):841-7. DOI: https://doi.org/10.1016/S0001-2092(06)63970-7

Hellinger WC, Bacalis LP, Edelhauser HF, Mamalis N, Milstein B, Masket S. Recommended practices for cleaning and sterilizing intraocular surgical instruments. J Cataract Refract Surg. 2007;33(6):1095-100. DOI: https://doi.org/10.1016/j.jcrs.2007.03.020

Clouser S. TASS prevention for perioperative nurses. Perioper Nurs Clin. 2010;5(3):397-9. DOI: https://doi.org/10.1016/j.cpen.2010.04.004

Burlew JA. Care and handling or ophthalmic microsurgical instruments. 2nd ed. Iowa: KENDALL; 2005. 53 p.

Brasil. Agência Nacional de Vigilância Sanitária (ANVISA). RDC Nº15 de 15 de março de 2012. Dispõe sobre requisitos de boas práticas para o processamento de produtos para saúde e dá outras providências. DOU Nº 54, de 19 de março de 2012. Seção 1, p. 43- 46.

Delyfer MN, Rougier MB, Leoni S, Zhang Q, Dalbon F, Colin J, et al. Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery. J Cataract Refract Surg. 2011;37(2):271-8. DOI: https://doi.org/10.1016/j.jcrs.2010.08.047

Johnston J. Toxic anterior segment syndrome - more than sterility meets the eye. AORN J. 2006;84(6):967-84. DOI: https://doi.org/10.1016/S0001-2092(06)63994-X

Eydelman MB, Tarver ME, Calogero D, Buchen SY, Alexander KY. The Food and Drug Administration’s proactive toxic anterior segment syndrome program. Ophthalmology. 2012;119(7):1297- 302. DOI: https://doi.org/10.1016/j.ophtha.2012.04.008

Doshi RR, Arevalo JF, Flynn Jr. HW, Cunningham Jr. ET. Evaluating exaggerated, prolonged, or delayed postoperative intraocular inflammation. Am J Ophthalmol. 2010;150(3):295- 304.e1. DOI: https://doi.org/10.1016/j.ajo.2010.04.012

Luz RA, Padoveze MC, Cvintal T. Epidemiologic surveillance of postoperative endophthalmitis in a specialized ophthalmologic center in São Paulo, Brazil. Am J Infect Control. 2012;40(1):e1-3. DOI: https://doi.org/10.1016/j.ajic.2011.05.017

Downloads

Published

2015-06-01

How to Cite

Luz, R. A., Padoveze, M. C., Souza, R. Q. de, Graziano, K. U., & Cvintal, T. (2015). Toxic anterior segment syndrome after cataract surgery: the implications for nursing. Revista SOBECC, 20(2), 96–103. https://doi.org/10.5327/Z1414-4425201500020005

Issue

Vol. 20 No. 2 (2015)

Section

REVIEW ARTICLES

License

By publishing in Revista SOBECC, authors retain the copyright of their article and agree to license their work using a Creative Commons Attribution (CC BY 4.0) International Public License, thus accepting the terms of this license. The CC BY 4.0 license allows others to distribute, remix, adapt, and create from the published article, even for commercial purposes, provided they give due credit to the creators of the work (authors of the article).

The authors grant to Revista SOBECC the right of first publication, to identify itself as the original publisher, and grant to the journal a non-exclusive license to use the work in the following ways: (1) to sell and/or distribute the article in hard copies and/or in electronic format; (2) to distribute parts and/or the entire article in order to promote the journal through the internet and other digital and printed media; (3) to record and reproduce the article in any format, including digital media.

With this license, authors can enter into separate contracts for non-exclusive distribution of the article (e.g., publishing in an institutional repository or as a book chapter), with acknowledgement of authorship and initial publication in Revista SOBECC. Authors are encouraged to publish and distribute their work online after publication in the Revista SOBECC, as this can increase the article's visibility and impact.

In line with the journal's policies, each published article will be assigned a CC BY 4.0 license, which will be visible on the abstract page and in the PDF of each article with the respective link to the license terms.