眼前节毒性综合征

白内障手术已经成为防盲治盲的主要眼科手术.术后炎症反应轻微,但是,近年来,发现了一种眼前节炎症综合征,不同于感染性炎症,属于特殊类型术后炎症,即毒性眼前节综合征(TASS).此文中从临床表现、病因、诊断、鉴别诊断、治疗和预防等方面对其进行作一综述.     

毒性眼前节综合征

毒性眼前节综合征是发生于白内障手术后早期、强烈的无菌性炎症反应,患者通常疼痛轻微或无疼痛,伴有弥漫性角膜水肿、前房纤维素性渗出、前房积脓等,而玻璃体不受影响。其致病原因有多种,包括平衡盐溶液内毒素、眼药防腐剂、眼内注射抗生素及麻醉剂、消毒灭菌不当、高压蒸气杂质、人工晶状体材料及质量、眼膏进入眼内等。此综合征糖皮质激素治疗有效,轻症患者多可恢复,而严重病例可造成持续性损伤,需进行角膜移植、抗青光眼手术等相应治疗。     

眼前节毒性综合征

眼前节毒性综合征(toxic anterior segment syndrome,TASS)是内眼术后眼前节的无菌性炎性反应,已成为一个重要的白内障手术并发症。手术中进入前房的各种非感染性毒剂均可能导致TASS的发生,主要表现为角膜弥漫性水肿、睫状充血、前房纤维素性渗出等,大多数患者糖皮质激素治疗有效,少数可遗留永久性眼内组织损伤,以至于影响视力,故早期诊断和治疗显得至关重要。我们现就TASS作一综述,希望能引起眼科医师的关注。     

眼前节毒性综合征

白内障手术已经成为防盲治盲的主要眼科手术,术后炎症反应轻微.但近年来,发现一种眼前节毒性综合征,不同于感染性炎症,属于特殊类型术后炎症.本文将从临床表现、病因、诊断、鉴别诊断、治疗和预防等方面对其进行综述.     

眼前节毒性反应综合征的研究进展

眼前节毒性综合征(toxic anterior segment syndrome,TASS)是一种眼前节急性非感染性的炎症反应.临床相对少见,但近年来,随着眼前节手术的发展,TASS有逐渐增多的趋势.手术中进入前房的各种非感染性物质均可能导致TASS的发生.大多数患者经及时、有效治疗后预后良好,但少数可遗留永久性眼内组织损伤,以至于影响视力.现从TASS的病理、诊断及鉴别诊断、病因、预防、治疗和预后等方面对其予以综述.     

毒性眼前节综合征

毒性眼前节综合征是眼前节的一种无菌性炎性反应,与多种进入眼前房物质的毒性作用有关,多于术后急性出现,表现为急性角膜水肿等眼前节炎性反应,治疗措施很有限,预后与毒性物质的强度有关.随着内眼手术的发展,有逐渐增加的趋势,重在预防.     

人工晶状体植入术后并发眼前节毒性综合征

目的：通过分析眼前节毒性反应综合征(toxic anterior segment syndrome, TASS)患者的临床表现, 寻找TASS的患者的发病原因、治疗方法及预后。

方法：通过前房及玻璃体穿刺培养的方法排除感染性细菌性眼内炎,考虑为TASS患者6例7眼,局部应用抗生素和糖皮质激素眼液及玻璃体腔注射万古霉素1mg及头孢他啶2mg治疗,观察治疗后效果。

结果：所有TASS患者前房液及玻璃体液培养均未见细菌生长。TASS患者1例2眼经局部类固醇激素眼液治疗,5例5眼经前房冲洗、玻璃体腔注药后,前房炎症明显好转,视力提高,随访6mo,未再出现眼部异常表现。查找致病因素时根据排除法考虑为消毒锅的原因,及时清洗和更换滤网后发生率明显降低。

结论：尽管TASS是眼前段手术的罕见并发症,及时查找致病原因,早期正确诊断及积极有效的治疗预后良好。     

眼前节毒性综合征一例

患者男性,55岁。因左眼白内障于2010年5月在我院行白内障超声乳化联合人工晶状体植入术。术前眼部检查：右眼为人工晶体眼,右眼视力1.0。左眼视力：0.1（矫正不提高）,左眼角膜透明,前房常深,瞳孔正圆,直径3 mm,对光反射灵敏。左眼晶体核Ⅱ级,后囊下混浊。玻璃体少量混浊。眼底未见异常改变。角膜内皮细胞计数：2791.6个/mm2。六角型细胞占69％。眼压：16 mm Hg,全身无糖尿病、高血压及其他免疫性疾病史。于表面麻醉下行白内障超声乳化联合人工晶状体植入术,手术顺利,术中后囊膜完整,人工晶状体囊袋内植入。     

毒性眼前节综合征一例

患者女,70岁.因双眼视力渐进性下降10余年于2009年2月2日以"双眼年龄相关性白内障"入院.既往近视眼病史数十年.入院检查全身状况良好.眼部检查:视力:双眼均CF/1m,矫正不应,光定位及红绿色觉均正常,双眼眼前节正常,双眼晶状体混浊,核Ⅲ级,眼后段窥不清,B超示玻璃体无明显混浊.     

眼前节毒性反应综合征一例

患儿男,12岁。因双眼视物不清8年入院。不伴有眼红、眼痛、畏光、流泪、视物变形等不适。既往体健,否认眼部外伤史及遗传和药物过敏史。专科检查：视力：双眼0．15,矫正0．15。眼压：右14mmHg,左13mmHg,双眼球结膜无充血,角膜透明,前房中深,KP（-）,房闪（-）,瞳孔圆,直径3mm,对光反应灵敏,晶状体皮质不均匀混浊（图1）,玻璃体及眼底窥不清。     

眼前段毒性综合征

眼前段毒性综合征是一种无菌性的术后炎性反应,具有典型的临床特征并可引起严重的继发性反应;病因繁多而复杂,目前已知的相关因素有灌注液和黏弹剂、眼内器械相关感染源、药物因素和人工晶状体等;易与感染性眼内炎相混淆,诊断比较困难;目前已报道的有效药物治疗主要是糖皮质激素治疗;重在预防.     

Toxic anterior segment syndrome

The authors present two cases of TASS which occurred consequent upon anterior chamber administration of cefuroxime(Axetin). The ESCRS guidelines on prevention, investigation and management of postoperative endophthalmitis recommends intracameral injection of an antibiotic agent (cephalosporin) at the conclusion of surgery. In our group of patients TASS occurred. Elements of diagnosis and treatment in TASS are discussed. As a conclusion to our study we decided to discontinue cefuroxime administration.     

Toxic anterior segment syndrome

Toxic anterior segment syndrome (TASS) is a sterile postoperative inflammatory reaction caused by a noninfectious substance that enters the anterior segment, resulting in toxic damage to intraocular tissues. The process typically starts 12 to 48 hours after cataract/anterior segment surgery, is limited to the anterior segment of the eye, is always Gram stain and culture negative, and usually improves with steroid treatment. The primary differential diagnosis is infectious endophthalmitis. Review of the literature indicates that possible causes of TASS include intraocular solutions with inappropriate chemical composition, concentration, pH, or osmolality; preservatives; denatured ophthalmic viscosurgical devices; enzymatic detergents; bacterial endotoxin; oxidized metal deposits and residues; and factors related to intraocular lenses such as residues from polishing or sterilizing compounds. An outbreak of TASS is an environmental and toxic control issue that requires complete analysis of all medications and fluids used during surgery, as well as complete review of operating room and sterilization protocols.     

Toxic anterior segment syndrome

Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells.     

Toxic anterior segment syndrome: A review

Toxic anterior segment syndrome is a surgical complication characterized by a noninfectious anterior chamber inflammatory reaction having multiple etiologies. The clinical signs (prominent limbus-to-limbus corneal edema, anterior chamber inflammation) and symptoms (decreased visual acuity, discomfort) generally occur within the first 12-48 hours after intraocular surgery. Most patients achieve good clinical and visual outcomes when there is a prompt clinical diagnosis and adequate treatment. We review the literature on toxic anterior segment syndrome, emphasizing its etiology, pathophysiology, and clinical and surgical management, as well as prognosis and sequelae. Our goal is to reduce the frequency of toxic anterior segment syndrome by highlighting the importance of prevention, early recognition, and distinguishing toxic anterior segment syndrome from infectious endophthalmitis.