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At post-operative week six, visual acuity had improved to 20/30 in the affected eye. Although most surgeons have abandoned intracameral use of agents containing preservatives, inadvertent administration of these preservatives may result in TASS. Benzalkonium chloride is a frequently cited offender, and care should be taken to ensure medications instilled intracamerally do not contain this preservative (69-71). This agent not only causes dose-related inflammation to extraocular structures like the conjunctiva, it is also reported to make structural alterations to the endothelium even at exceedingly low concentrations (110).
One of the most widespread TASS outbreaks was from aluminum toxicity related to the use of HOYA iSert one-piece intraocular lenses, (HOYA Co Ltd, Tokyo, Japan) (61,67). Six cases were also subsequently identified to cause late-onset TASS (68). A review of manufacturing practices revealed residual metallic particles on these intraocular lenses as the cause. Bodnar et al. sought to assess how risk factors have changed for TASS over a decade, specifically before and after 2009. Their findings suggest that education and increased awareness of TASS may have improved preoperative sterilization practices (104). The Toronto Alexithymia Scale (TAS-20) is a self-report questionnaire that measures alexithymia.
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TASS is an acute sterile anterior chamber inflammatory reaction that usually develops hours after anterior segment surgery. Late-onset TASS has also been reported. The condition is responsive to topical steroids in most cases. Risk factors for endophthalmitis include preoperative, intraoperative, and postoperative factors. Preoperative factors include uncontrolled blepharitis or other ocular surface disease, diabetes mellitus, an immunocompromised state, infectious foci near the surgical site, and advanced age (5,10-12).
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