Werner Liliana, Sher Jeffrey H, Taylor Joel R, Mamalis Nick, Nash Wesley A, Csordas James E, Green George, Maziarz E Peter, Liu X Michael
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
J Cataract Refract Surg. 2006 Feb;32(2):227-35. doi: 10.1016/j.jcrs.2005.12.093.
To report clinical and laboratory findings of 8 cases of toxic anterior segment syndrome (TASS) related to an oily substance in the anterior chamber of patients following cataract surgery with intraocular lens (IOL) implantation.
John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
Eight patients had uneventful phacoemulsification by the same surgeon via clear corneal incisions with implantation of the same 3-piece silicone IOL design. Postoperative medications included antibiotic/steroid ointment and pilocarpine gel; each eye was firmly patched at the end of the procedure. On the first postoperative day, some patients presented with diffuse corneal edema, increased intraocular pressure, and an oily film-like material within the anterior chamber coating the corneal endothelium. The others presented with an oily bubble floating inside the anterior chamber, which was later seen coating the IOL. Additional surgical procedures required included penetrating keratoplasty, IOL explantation, and trabeculectomy. Two corneal buttons were analyzed histopathologically. Two explanted IOLs had gross and light microscopic analyses (as well as surface analyses of 1 of them), and 4 other explanted IOLs had gas chromatography-mass spectrometry.
Pathological examination of the corneas showed variable thinning of the epithelium with edema. The stroma was diffusely thickened and the endothelial cell layer was absent. Evaluation of the explanted IOLs confirmed the presence of an oily substance coating large areas of their anterior and posterior optic surfaces. Gas chromatography-mass spectrometry of the lens extracts identified a mixed chain hydrocarbon compound that was also found in the gas chromatography-mass spectrometry analyses of the ointment used postoperatively.
The results indicate that the ointment gained access to the eye, causing the postoperative complications described. These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment.
报告8例白内障手术联合人工晶状体（IOL）植入术后患者前房内油性物质相关的毒性前段综合征（TASS）的临床和实验室检查结果。
美国犹他州盐湖城犹他大学约翰·莫兰眼科中心。
8例患者由同一位外科医生经透明角膜切口行超声乳化白内障吸除术，并植入相同的三片式硅胶IOL。术后用药包括抗生素/类固醇眼膏和毛果芸香碱凝胶；手术结束时每只眼均牢固包扎。术后第1天，部分患者出现弥漫性角膜水肿、眼压升高，前房内有一层油性薄膜样物质覆盖角膜内皮。其他患者前房内有一个油性气泡漂浮，随后可见其覆盖人工晶状体。所需的额外手术包括穿透性角膜移植术、人工晶状体取出术和小梁切除术。对两片角膜植片进行了组织病理学分析。对两枚取出的人工晶状体进行了大体和光学显微镜分析（其中一枚还进行了表面分析），另外四枚取出的人工晶状体进行了气相色谱 - 质谱分析。
角膜的病理检查显示上皮可变薄伴水肿。基质弥漫性增厚，内皮细胞层缺失。对取出的人工晶状体的评估证实其前后光学表面大面积有油性物质覆盖。晶状体提取物的气相色谱 - 质谱分析鉴定出一种混合链烃化合物，在术后使用的眼膏的气相色谱 - 质谱分析中也发现了该化合物。
结果表明眼膏进入眼内导致了所述的术后并发症。这些病例突出了合适的伤口构建和完整性的重要性，以及使用眼膏后紧密包扎眼睛的风险。
