Journal Information
Vol. 32. Issue 6.
Pages 339-343 (January 2008)
Vol. 32. Issue 6.
Pages 339-343 (January 2008)
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Toxic anterior segment syndrome (TASS): studying an outbreak
Síndrome tóxico del segmento anterior: investigación de un brote
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M. Sarobe Carricasa,
Corresponding author
msarobec@cfnavarra.es

Correspondence: Servicio de Farmacia. Hospital de Navarra. C/Irunlarrea, 3. 31008 Pamplona. Navarra. España.
, G. Segrelles Bellmunta, L. Jiménez Lasantab, A. Iruin Sanza
a Servicio de Farmacia, Hospital de Navarra, Pamplona, Spain
b Servicio de Oftalmología, Hospital de Navarra, Pamplona, Spain
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Abstract
Introduction

An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients.

Methods

As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases.

Results

According to the results obtained in the biochemical, microbiological, pH, osmolarity, and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct.

Discussion

Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the readministration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used.

Keywords:
Toxic anterior segment syndrome
Cataract surgery
Balanced salt solution
Complications of cataract surgery
Endophtalmitis
Cleaning of intraocular surgical instruments
Introducción

En los últimos años se ha descrito una complicación asociada a la cirugía de cataratas, el síndrome tóxico del segmento anterior. Es un proceso inflamatorio que aparece en las primeras horas tras la cirugía, de carácter no infeccioso y que generalmente se resuelve bien con corticoides tópicos si el tratamiento se instaura con prontitud. En el presente trabajo se describe este síndrome y se analizan las posibles causas de un brote que tuvo lugar en nuestro centro y que afectó a 5 pacientes.

Métodos

Se creó un grupo de investigación en el centro que revisó todos los procedimientos implicados, puesto que las causas del síndrome pueden ser múltiples. Se analizaron desde los métodos de lavado y esterilización de material hasta los medicamentos y sustancias utilizadas que pudieron ser causa del brote. Entre estos últimos, serevisaron las sustancias elaboradas en el servicio de farmacia, en especial la solución salina irrigadora, utilizada en todos los casos.

Resultados

Los resultados bioquímicos, microbiológicos, de pH, osmolaridad y de endotoxinas indicaron que las soluciones elaboradas en el servicio de farmacia eran correctas.

Discusión

Dado que los resultados de los análisis de las sustancias empleadas eran correctos, corroborados con su reintroducción sin efecto adverso alguno, se llegó a la conclusión de que el brote más bien estaría relacionado con el proceso de lavado previo a la esterilización del instrumental utilizado en la cirugía, ya que no se estaban siguiendo las recomendaciones de uso de agua destilada y estéril para este fin, sino que, por el contrario, se estaba utilizando agua corriente de la red.

Palabras clave:
Síndrome tóxico del segmento anterior
Cirugía de cataratas
Solución BSS
Complicaciones de la cirugía de cataratas
Endoftalmitis
Lavado de instrumental quirúrgico intraocular
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A communication about the outbreak was presented in the Conference of the Spanish Ophthalmology Society: J. Andonegui, L. Jiménez, D. Aliseda, F. Lameiro. Description of an outbreak of toxic anterior segment síndrome after vitreous surgery. 83rd Conference of the Spanish Ophthalmology Society. Las Palmas de Gran Canaria, September 26-27, 2007.

Copyright © 2008. Sociedad Española de Farmacia Hospitalaria
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