Challenges in the diagnosis and management of simultaneous bilateral toxic anterior segment syndrome after phacorefactive surgery

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A mild-corectopic pupil was observed at the site of the fibrin membrane seen at first visit in the right eye.
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Published: Apr 24, 2023
DOI: https://doi.org/10.5693/djo.02.2023.01.003
Keywords:
clear lens extraction immediately sequential bilateral cataract surgery refractive lens exchange toxic anterior segment syndrome

Main Article Content

Raul E. Ruiz-Lozano, MD
Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
https://orcid.org/0000-0001-7022-2395
Eugenia M. Ramos-Davila, MD
Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
https://orcid.org/0000-0002-1105-2848
Lucas A. Garza-Garza, MD
Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
https://orcid.org/0000-0003-2889-0757
Sara Gonzalez-Godinez, MD, PhD
Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
https://orcid.org/0000-0002-2387-8196
Alejandro Rodriguez-Garcia, MD
Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
https://orcid.org/0000-0002-1419-2109

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, conjunctival chemosis, eyelid edema, and erythema raised suspicion for bilateral toxic anterior segment syndrome. 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.

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How to Cite
1.
Ruiz-Lozano RE, Ramos-Davila EM, Garza-Garza LA, Gonzalez-Godinez S, Rodriguez-Garcia A. Challenges in the diagnosis and management of simultaneous bilateral toxic anterior segment syndrome after phacorefactive surgery. Digit J Ophthalmol. 2023;29(2):40-44. doi:10.5693/djo.02.2023.01.003
Issue
Vol. 29 No. 2 (2023)
Section
Case Reports
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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