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Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen Soaked in Ortho-Phthalaldehyde

Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen Soaked in Ortho-Phthalaldehyde Guadalupe Cervantes-Coste MD Victoria Mercado-Banegas MD Authors have no financial interest Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez- Bulnes”.

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Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen Soaked in Ortho-Phthalaldehyde

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  1. Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen Soaked in Ortho-Phthalaldehyde Guadalupe Cervantes-Coste MD Victoria Mercado-Banegas MD Authors have no financial interest Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez- Bulnes”

  2. Toxic Anterior Segment Syndrome Sterile post-op inflammatory reaction caused non-infectious substance TOXIC damage to intraocular tissues ACUTE… …afteranterior segment Surgery 12- 48hours post-op

  3. Etiologies: • Ocular medications Antiseptics • Preservatives Sterilizing agents • Cleaning agents Talc IOLs • Viscosurgical devices Endotoxins • Clinical Findings: • Descemet´s membrane folds • Anterior segment inflammation • Diffuse, limbus-to-limbus,corneal edema • Widespread endothelial damage • Fibrin deposits • Irregular and unreactive pupil • Ocular hypertension & trabecular damage

  4. Clinical Case: Uneventful phacoemulsification cataract surgery + acrylic IOL Infinity Alcon, 2.8 mm incision , continuous OZil CDE: 9 trans-op medication: Intracameral vacomycin Phaco tip andsleeve cleaned Ortho-Phthalaldehyde 2%solution

  5. TASS • Medical History: • 48 yr woman with metabolic cataracts OU • DM II treated with insulin • BCVA: OU: Count fingers 2 m • Anterior segment: • OU: Cataracts : N+++ • posterior sub capsular opacity + (LOCS III) • IOL calculation (immersion ultrasound) • SRK-T formula • power: +24.00 D

  6. 1st daypost-phaco: • moderate ocular pain • conjunctival injection • limbus-to-limbus corneal edema +++ , irregular endothelium • cells +++ • fibrinbands in 4 quadrants • mydriatic and a-reflective pupil • IOP 10 mmHg • Treatment: • Transeptal , topical and oral steroids • Topical antibiotic

  7. 3er daypost-phaco: • Ultrasound:normal • Pain decreased, blurring • Anterior segment: no changes • Adding treatment: • Hypotensors , NaCl 0.5% & vitamin C • 13 dayspost-phaco: • Nopain but blurring • Corneal edema in 3 quadrants • Fibrin bands at 360° • Cells +++ • Iridocorneal synechiaes

  8. 20 dayspost-phaco: • Decreased pain • BCVA: 1/10 • Corneal edema in 3 quadrants • Cells++ • Fibrin bands extending to irido-corneal angle • IOP 18 mmHg • Same treatment

  9. Anterior capsulotomy (YAG) • 22 dayspost-phaco: • intense ocular pain, headache and blurring • conjunctival injection • epithelial corneal edema • cells ++ • IOP: 38mmHg • 360° angle closure • Unresponsive to treatment • Charbonic anhidrase inhibitors • Beta- blocker • Adrenergic agonist

  10. Amhed Valveimplant • 1st daypost-Valve: • clear cornea, Valve tube in-situ • AC: cells ++ IOP: 4mmHg • optic nerve cup: 7/10 • Treatment: • Topical steroids & antibiotics • Lubricants • 8–15 dayspost-Valve: • vision “subjectively” improved • clear cornea • IOP 7 -12mmHg • fibrinmembrane without changes

  11. 22dayspost-Valve: • intense pain and blurring • ciliary injection ++ • epithelial corneal edema • AC: cells++ IOP: 38mmHg • 360°angle closure Unresponsive to treatment: • 1 monthpost-Valve: • “blurring” , VA: CF 10 cm • diffuse corneal edema in 4 quadrants • IOP 14 mmHg Final diagnosis: “Corneal decompensation”

  12. Differential Diagnosis Glutaraldehyde • signs of infectious absent • ultrasound NO disturbance of vitreous • NO response topical prednisolone and non-steroidal • final Visual Acuity NO improvement during follow-up • irregular pupil NOTreactive to light or medication Conclusions • colorless liquid & best disinfectant cold sterilization • enzymes of detergents deactivated to 140° C or • most autoclaves reach 120 to 130° C • small lumen instruments… … possibly reservoirs sterilizing solution residue • TASSfrom sterilizing solutions residue PREVENTABLE

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