Balparda Kepa, Vanegas-Ramirez Claudia Marcela, Márquez-Tróchez Johny, Herrera-Chalarca Tatiana
Department of Cornea and Refractive Surgery, Black Mammoth Surgical, Medellín, Colombia.
Department of Ophthalmology, Universidad Pontificia Bolivariana, Medellín, Colombia.
Case Rep Ophthalmol Med. 2020 Nov 3;2020:1216578. doi: 10.1155/2020/1216578. eCollection 2020.
Phakic Intraocular Lens (P-IOL) implantation is a safe, easy, predictable intervention designed to manage moderate to high refractive errors. Complications are relatively uncommon and include mainly cataract and intraocular pressure spikes. Toxic Anterior Segment Syndrome (TASS) is a rather unusual sterile anterior segment inflammation after uneventful intraocular surgery, extremely rarely reported after P-IOL implantation. Urrets-Zavalia Syndrome (UZS) is also very rarely described after P-IOL. To date, to the best of the authors' knowledge, no article has ever described the simultaneous occurrence of TASS and UZS in a patient after P-IOL implantation.
In this article, the authors present the case of a female patient with moderate myopic astigmatism, who underwent sequential P-IOL implantation at two different facilities. The postoperative course of the first eye was uneventful, but she developed complications associated to the intervention in the second eye.
The article describes the case of a young patient who underwent a sequential Phakic Intraocular Lens (P-IOL) implantation at two different institutions. The postoperative course of the first eye (left eye) was uneventful; however, the second eye (right eye) initially developed Toxic Anterior Segment Syndrome (TASS). Although timely and correct management was instituted, upon resolution of TASS, the patient developed Urrets-Zavalia Syndrome, anterior subcapsular cataract, and significant endothelial damage in the same eye.
The patient was followed closely and managed accordingly; corneal edema and anterior segment inflammation of the right eye eventually resolved. Nevertheless, an anterior subcapsular cataract and a fixed dilated pupil remained; with normal intraocular pressure (IOP). Specular microscopy confirmed an endothelial cell loss in the TASS eye (right eye). Pupil size showed no reaction to repeated doses of Pilocarpine 2%. A month after surgery, refraction on her right eye was +0.25 + 0.75 × 93, which resulted in a 20/50 vision.
TASS and UZS are both extremely rare complications after uneventful P-IOL implantation, with only a handful of cases having been reported of each of them. To date, this is the very first case where UZS ensued after and potentially as a consequence of TASS in a patient who had undergone P-IOL implantation. Although a direct causative element could not be pinpointed, the fact that the complication ensued after being operated in one surgical institution and not the other, could suggest some role of different sterilization and handling procedures, but no direct conclusion can be made on this case.
有晶状体眼人工晶状体（P-IOL）植入术是一种安全、简便、可预测的干预措施，旨在治疗中高度屈光不正。并发症相对少见，主要包括白内障和眼压急剧升高。毒性眼前节综合征（TASS）是一种在无并发症的眼内手术后相当罕见的无菌性眼前节炎症，在P-IOL植入术后极少报道。乌雷茨-萨瓦利亚综合征（UZS）在P-IOL植入术后也非常罕见。迄今为止，据作者所知，尚无文章描述过P-IOL植入术后患者同时发生TASS和UZS的情况。
在本文中，作者介绍了一名患有中度近视散光的女性患者的病例，该患者在两个不同机构先后接受了P-IOL植入术。第一只眼的术后过程顺利，但第二只眼出现了与手术相关的并发症。
本文描述了一名年轻患者在两个不同机构先后接受有晶状体眼人工晶状体（P-IOL）植入术的病例。第一只眼（左眼）的术后过程顺利；然而，第二只眼（右眼）最初出现了毒性眼前节综合征（TASS）。尽管及时采取了正确的处理措施，但在TASS消退后，该患者在同一只眼中出现了乌雷茨-萨瓦利亚综合征、前囊下白内障和明显的内皮损伤。
对该患者进行了密切随访并相应处理；右眼的角膜水肿和眼前节炎症最终消退。然而，前囊下白内障和固定性散大瞳孔仍然存在；眼压正常（IOP）。镜面显微镜检查证实TASS眼（右眼）存在内皮细胞丢失。瞳孔大小对重复给予的2%毛果芸香碱无反应。术后一个月，她右眼的验光结果为+0.25 + 0.75 × 93，视力为20/50。
TASS和UZS都是P-IOL植入术后极为罕见的并发症，每种并发症仅报道过少数病例。迄今为止，这是首例在接受P-IOL植入术的患者中，TASS之后继而出现UZS且可能是其后果的病例。尽管无法确定直接的致病因素，但该并发症在一个手术机构而非另一个机构手术后出现这一事实，可能提示不同的消毒和处理程序发挥了一定作用，但就此病例无法得出直接结论。
