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J Cataract Refract Surg. 2011 Sep;37(9):1673-8. doi: 10.1016/j.jcrs.2011.03.053. Epub 2011 Jul 22.

Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital.

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Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.



To determine the incidence and long-term outcomes of toxic anterior segment syndrome (TASS) at a single institution.


Aravind Eye Hospital, Pondicherry, India.


Case series.


The records of all eyes developing TASS during a 1-year period after cataract surgery were retrospectively reviewed. Clinical outcomes, including corrected distance visual acuity (CDVA), intraocular pressure, and complications, were recorded at the 1-month and 6-month follow-up visits.


Toxic anterior segment syndrome occurred in 60 eyes (0.22%) in 26 408 consecutive cataract surgeries. Although there were 2 identifiable clusters of TASS, 52% of cases were sporadic. The mean duration until resolution of severe iridocyclitis was 6.11 days ± 2.19 (SD). Of the 24 eyes (40%) with a follow-up of at least 6 months (mean 11.24 ± 2.3 months), 6 (24%) had atrophic iris changes, 1 (4%) had cystoid macular edema, 3 (12.5%) developed anterior capsule phimosis, and 4 (16%) had posterior capsule opacification (PCO). There was no statistically significant difference between the mean CDVA at 1 month (0.08 ± 0.06 logMAR) (n = 60) and the mean final CDVA (0.11 ± 0.1 logMAR, minimum 6 months; n = 24) (P=.42).


Although it is impossible to generalize for all etiologies, this study found that TASS is uncommon but not rare, responded to intensive topical antiinflammatory medication, and was usually associated with a good visual outcome. Anterior capsule contraction and PCO were the principal delayed-onset complications beyond those present 1 month postoperatively.

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