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However, postoperative endophthalmitis and toxic anterior segment syndrome (TASS) remain important challenges. Both endophthalmitis and TASS can present as severe postoperative inflammation, and clinical characteristics may be used to differentiate between the two (Table 1). Without prompt treatment, both may lead to poor visual outcomes. Although these entities cannot be prevented completely, their rates may be decreased through risk reduction strategies supported by peer-reviewed evidence.
The most common causative organisms causing acute-onset postoperative endophthalmitis are gram-positive bacteria, accounting for 94.2% of culture-positive cases in the EVS. Within this group, coagulase-negative staphylococci were more common than Staphylococcus aureus and streptococci (70% vs. 9.9% and 9%, respectively) (2). Subsequent large series generally corroborate these rates (13,19,20). Of the remainder, gram-negative species account for approximately 5% which includes Proteus, Haemophilus influenzae, and Pseudomonas (2,21).
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- The response is typically apparent and symptomatic hours after surgery.
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).
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Most TASS patients respond well to topical corticosteroids (such as 1% Prednisolone acetate) given hourly. Mild or early cases will respond to steroids rapidly as evidenced by clearing of the inflammation and decrease in intraocular pressure. In cases of moderate TASS, the clearing may take up to 3-6 weeks.
Match winner, total sets, and correct score. One of the most widespread TASS outbreaks was from aluminum toxicity related to the use of HOYA iSert one-piece intraocular lenses, (HOYA Co Ltd, Tokyo, Japan) (61,67). Six cases were also subsequently identified to cause late-onset TASS (68). A review of manufacturing practices revealed residual metallic particles on these intraocular lenses as the cause.
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