Fibrin glue may cause TASS

Chicago-Fibrin glue might be a potential cause of toxic anterior segment syndrome (TASS). During the American Society of Cataract and Refractive Surgery annual meeting, Selcuk Sizmaz, MD, reported four cases of TASS that developed after uneventful phacoemulsification and IOL implantation.

The four cases (two men, two women) were the initial consecutive two cases that developed on two different surgical days. All patients underwent uneventful surgery for age-related cataract. At presentation, the patients had severe corneal edema that extended from limbus to limbus. The IOP was elevated in three cases. Two patients reported pain, according to Dr. Sizmaz, who is from Baskent University School of Medicine, Ankara, Turkey.

All of the patients were treated with prednisolone acetate drops hourly, 5% sodium chloride three times a day, ofloxacin four times a day, oral acetazolamide three times a day for high IOP, and subconjunctival dexamethasone (0.2 ml, 4 mg/ml) from the second to the sixth treatment days, Dr. Sizmaz recounted.

In the three affected patients, the IOP returned to normal. The steroid therapy was tapered over 6 weeks in two patients. The other two patients had persistent cornea edema and underwent penetrating keratoplasty. In two patients the pupils were fixed and dilated, and they were unresponsive to light.

Dr. Sizmaz and colleagues experienced two outbreaks of TASS 5 months apart. The cases were the first two cases treated on two different surgical days. The rest of the patients who underwent surgery on those two days were not affected. The investigators reviewed all preoperative, intraoperative, and postoperative procedures to determine the cause of the TASS.

“The two outbreaks were not distinguished by means of preoperative or intraoperative procedures,” he commented. “Both outbreaks were preceded by pterygium excisions during which fibrin glue was used; those [procedures] were performed at the end of the two preceding days.”

Fibrin glue has been thought to be a relatively benign product. In one experimental study, there was no evidence of toxicity in cultured bovine endothelial cells; another study in rabbits also reported no damage to the corneal endothelial cells.

The investigators concluded that remnants of fibrin glue on the surgical equipment that was denatured by sterilization might have caused the TASS outbreaks.

“TASS is a sight-threatening condition that requires thorough investigation to prevent development of new cases,” Dr. Sizmaz said.

Dr. Sizmaz has no financial interest in this subject matter.

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