Toxic anterior segment syndrome following deep anterior lamellar keratoplasty

ABSTRACT We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS) that developed after undergoing deep anterior lamellar keratoplasty (DALK). She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA) was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber.

摘要 我们报告1例31岁患者在接受深板层角膜移植术（deep anterior lamellar keratoplasty, DALK）后发生中毒性眼前节综合征（toxic anterior segment syndrome, TASS）的临床病例。该患者罹患圆锥角膜，尽管左眼多年佩戴硬性接触镜（hard contact lenses），但视力仍持续下降，遂对左眼实施DALK手术。术前视力（visual acuity, VA）为3米处数指，手术采用常规“大泡法”（big-bubble technique）完成，术毕对角膜切口行水密处理，并通过前房（anterior chamber）内注气结束操作。术后第1天，患者视力降至手动水平，角膜出现水肿。结合TASS的临床诊断，予局部大剂量地塞米松（topical high-dose dexamethasone）及口服糖皮质激素（oral steroids）治疗。后续患者视力逐步提升，角膜水肿消退。我们认为，使用再次灭菌的套管针（re-sterilized cannulas）可能是诱发本次TASS的潜在原因。尽管DALK手术无需侵入前房，但仍需警惕：用于切口水密处理的制剂及前房内注入的空气均可能引发TASS。