Toxic Anterior Segment Syndrome and How to Help Avoid an Outbreak in Your Facility
October 20, 2009 by Jason Carpenter
Filed under OR Management
Toxic Anterior Segment Syndrome, commonly known as TASS, is a concerning and feared occurrence when a patient is diagnosed following an uneventful cataract surgery. Surgeons and the facilities they perform cases in are required to scrutinize procedures and protocols in order to try to solve the originating source of this inflammation. This is often a trying and sometimes impossible task to take on. However trying the task, it is extremely important to investigate possible sources.
Toxic Anterior Segment Syndrome is an acute inflammation that occurs postoperatively. It occurs when a noninfectious substance enters the anterior chamber of the eye and inflicts toxic damage to intraocular tissue. It is often confused with endophthalmitis, but is actually quite different. TASS has a very rapid onset, usually within 12-24 hours following surgery, while endophthalmitis often takes 2-7 days to show. The TASS patient rarely experiences pain and shows limbus to limbus edema, while those diagnosed with endophthalmitis often experience severe pain and edema only at the site of the trauma. Endophthalmitis patients also have shown to have vitreal inflammation, lid swelling, and reactive pupil. Those afflicted with TASS rarely experience vitritis, have a non-reactive or fixed pupil, and usually don’t have any swelling in the lids. The other symptom that may help distinguish between the two is intraocular pressure. TASS patients often experience a rapid change in pressure while those with endophthalmitis rarely experience a change in IOP.
Treatment for TASS is a regimen of topical steroids and constant monitoring/assessment of the associated edema and elevated intraocular pressure. Normally, if caught early and correctly diagnosed, steroid treatments will drastically improve the patient’s condition. However, if medical treatment is unresponsive it may require surgical procedures including IOL exchange (if suspected to be source), corneal transplant (if cornea becomes seriously compromised), and sometimes a valve procedure if the IOP can’t be controlled properly.
There have been a variety of suspected causes for TASS. Some of the most common offenders were recently identified in an article entitled “Toxic Anterior Segment Syndrome Common Offenders” found in the August 2009 edition of Outpatient Surgery Magazine. A TASS task force determined the most common factor that contributes to Toxic Anterior Segment Syndrome is insufficient flushing of phaco and I/A handpieces. The task force recommends that all handpieces are to be flushed with no less than 120cc of sterile or distilled water. This will insure that all debris and viscoelastic has been removed and not been dried inside of the handpieces. Enzymatic cleaners and ultrasound baths were also noted as potential offenders. If properly flushed and cleaned, there is not a need for enzymatic cleaners that contain toxins that may not be denatured in the sterilization process. Ultrasonic cleaners can also lead to bacterial growth in the water that may be accumulated over time and remain on the instruments even after sterilization as well. Inappropriately mixed antibiotics have also shown to be a contributing source as well as preservatives including BAK (benzalkonium chloride), the most common preservative used in conjunction with ophthalmic solutions and medications. Reuse of single use items such as blades, tips, sleeves, and cannulas have also been shown to accumulate debris and result in toxin build up as well.
Toxic Anterior Segment Syndrome is a potentially serious issue for patients, surgeons and facility staff. It is extremely important to stay educated on possible causes and evaluate your procedures and protocols accordingly to make every effort to avoid any potential risks. TASS may not be completely preventable due to such a wide variety of factors, but it can be easily controlled and kept to a minimum with a proactive approach and intense investigation when a case does occur.
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A post by "Jason Carpenter" http://www.VantageOutsourcing.com Jason Carpenter brings to Cataract Outsourcing, an extensive career in the Operation field. Jason has been instrumental in the evaluation and selection of technologies which will better the healthcare industry. In addition to his Operations experience, Jason is a valued, journalist at Cataract Outsourcing. |
