Investigation of Toxic Anterior Segment Syndrome (TASS) in a day surgery centre

Timothy Roberts1,2, Sharon McIntyre3

Meeting:  2019 RANZCO


Date:      -

Session Title: Cataract

Session Time:      -

Background: Although the incidence of TASS following cataract surgery remains minimal, if present TASS represents a significant complication requiring additional treatment. The cause of TASS is often difficult to confirm and consideration of all possible individual and surgical causative factors is essential to minimise further cases. We undertake an audit of suspected TASS cases in a busy ophthalmic day surgery.

Benchmarking/Standard: RANZCO TASS guidelines.

Methods: Following reported TASS cases in an ambulatory day surgery centre, a local review was undertaken including analysis of sterilisation resources. An additional external review incorporating the existing RANZCO guidelines and a broader literature search was undertaken to assess potential patient and surgical risk factors and to deliver further recommendations if appropriate.

Results: Mean age of patients was 73.3 years. A history of systemic disease was found in the majority of patients. There did not appear to be a correlation between surgery time, staff availability, direct sterilisation procedures or instrumentation. On initial monitoring, sterilisation units exceeded acceptable levels of endotoxins corresponding to similar finding in the distilled water.

Recommendations: Increased endotoxins in distilled water appeared to represent a likely contributing factor however other plausible risk factors were identified. Following review, the source of distilled water was changed in addition to the steriliser preparation protocol. Several further recommendations were made upon external review which will further be discussed.