Challenges in the diagnosis and management of simultaneous, bilateral, toxic anterior segment syndrome after phacorefractive surgery Academic Article in Scopus uri icon

abstract

  • A 59-year-old woman presented with a 24-hour history of severe, bilateral, painless vision loss starting 1 day after immediately sequential, bilateral, phacorefractive surgery with multifocal intraocular lens (IOL) implantation at another institution. Best-corrected visual acuity was counting fingers at 1 foot in the right eye and 20/100 in the left eye. Slit-lamp evaluation showed a dense fibrin membrane on the anterior surface of the IOL and significant anterior chamber inflammation in both eyes. B-scan ultrasound revealed bilateral vitreous haze, without membrane formation. The rapid onset, absence of sharp pain, ciliary injection, con-junctival chemosis, eyelid edema, and erythema raised suspicion for bilateral toxic anterior segment syn-drome. Significant clinical improvement after high-dose prednisone and hourly prednisolone acetate eye drops supported the diagnosis. After 6 months of tapering anti-inflammatory therapy, optical coherence tomography of the macula showed no pathologic changes, and the patient¿s best-corrected visual acuity improved to 20/25 in both eyes. © The authors 2023.

publication date

  • January 1, 2023