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Preoperative factors include uncontrolled blepharitis or tas 71 download apk other ocular surface disease, diabetes mellitus, an immunocompromised state, infectious foci near the surgical site, and advanced age (5,10-12). Intraoperative factors include large-incision extracapsular cataract extraction, clear cornea incision, posterior capsule rupture with or without vitreous loss, and a less experienced surgeon (3,10-13). Some authors report the non-use of intracameral antibiotics as a risk factor, but the overall benefit of intracameral antibiotics remains controversial, especially in the US (14-16). Postoperative factors include early wound leak (17,18). Clinical diagnosis is made based on many factors.

Slit lamp photograph of a patient with TASS. (A) Diffuse Descemet’s folds and limbus to limbus corneal edema; (B) an anterior chamber 4+ inflammatory cell reaction without hypopyon. Investigators at one center found an ointment containing gentamicin and betamethasone as a likely cause of eight TASS related cases, performed by the same surgeon. Mass spectrometry identified a mixed chain hydrocarbon compound on both the intraocular lens extract and within the ointment used post-operatively. The authors suggested that wound integrity and tight eye patching that was used may have contributed to the ointment gaining access into the anterior chamber.

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• On rare severe cases, there is a need for further surgical intervention.
• In the EVS, approximately 30% of patients were culture negative (21).

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That seems to be a lot of issues in only 20 statements, but the total Alexithymia score does appear to be accurate, in that it reflects the challenges I deal with. If TASS develops, then there is usually a need for intraocular aqueous and vitreous tap for culture to rule out other diagnoses such as infection. In severe cases of TASS with persistent corneal edema, patients may need corneal transplantation. In refractory glaucoma, the eye pressure should be closely monitored.

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TASS is a non-infectious postoperative inflammation that occurs most commonly after cataract surgery but also may occur following keratoplasty and posterior segment procedures (52-55). It was first described in 1980 when nine eyes with intraocular lenses containing residual polishing compound on their surface developed sterile hypopyon (56,57). The incidence of TASS is difficult to estimate as it is uncommon and manifests both sporadically and in clustered outbreaks. The incidence following cataract surgery is likely around 1 in 1,000 (1,58). Although there is no conclusive evidence supporting the use of topical antibiotic prophylaxis, these agents are very widely used.

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Although the pathophysiology remains elusive, TASS typically represents an inflammatory response to a noninfectious substance introduced into the eye during surgery. As with all cases of post-operative inflammation following cataract surgery, endophthalmitis must be considered. In the case presented here, there was a lower suspicion for endophthalmitis as symptoms were very acute in onset—within 24 hours of surgery, and the inflammation was predominantly anterior without evidence of vitritis. An additional characteristic of TASS includes limited description of pain from the patient; blurry vision predominates. Importantly, there is commonly not a source identified for TASS, as in this case. Institutional awareness and prompt reporting of TASS should be a priority upon diagnosis.

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