Outbreak of Late-onset Toxic Anterior Segment Syndrome After Implantation of One-piece Intraocular Lenses

PURPOSE: To describe clinical findings associated with an outbreak of toxic anterior segment syndrome (TASS) after implantation of 1-piece intraocular lenses (IOLs; HOYA iSert (R) 251 and 255; HOYA Co Ltd, Tokyo, Japan) contaminated with aluminum. DESIGN: Multicenter observational retrospective case series. METHODS: Cases developing TASS after IOL implantation from November 2011 to February 2013 were reported to the HOYA IOL-Related Endophthalmitis Investigation Committee. Infectious endophthalmitis was excluded. Data were collected on patient backgrounds, the time from IOL implantation to development of the first symptoms, clinical findings, treatment, and best-corrected visual acuity (BCVA) scores before and after treatment. BCVA data were converted into logMAR figures to allow for statistical analysis. RESULTS: We identified 251 cases of late-onset TASS in patients of mean age 72.85 years treated in 183 hospitals. Common clinical features included the presence of anterior chamber cells (99.2%), conjunctival injection (41.4%), fibrinous inflammation (26.7%), and hypopyon (22.7%). Mean BCVA at the onset of ocular inflammation was 0.253 +/- 0.424. The mean time from IOL implantation to development of the first symptoms was 38.44 +/- 32.29 days. Of all eyes, 142 were treated with steroids and antibiotics, and 109 underwent surgery, including washing of the anterior chamber, removal of the IOL, and vitrectomy. Mean BCVA after treatment was 0.036 +/- 0.242, significantly better than at the onset of ocular inflammation (P < .05). CONCLUSION: This is the first report of an outbreak of late-onset TASS after implantation of a particular type of IOL. (C) 2015 by Elsevier Inc. All rights reserved.