Prolonged Toxic Anterior Segment Syndrome

A 74-year-old female presented with acute visual deterioration in the left eye 10 days after uncomplicated cataract surgery. Visual acuity was positive finger counting, with an intraocular pressure of 17 mmHg. Slit-lamp examination showed a severe inflammatory reaction of the anterior chamber with cells SUN 3+ and a fibrin membrane in the pupillary plane, which limited fundus view as well as the view on the implanted IOL.

Ultrasound examination showed no signs of endophthalmitis. CASIA2 was used to document and visualise the extent of the inflammation. The fibrin layer was clearly visualised through the 18 radial sections and showed an attachment of the membrane to the paracentesis. The severe inflammatory reaction in the anterior chamber could also be visualised.

She was then hospitalised with suspected prolonged toxic anterior segment ­syndrome and received topical corticosteroids as well as pressure regulators. The progression was continuously monitored using the CASIA2 and showed ­improvement throughout the stay. The OCT images of the ­anterior chamber inflammatory reaction clearly correlated with the clinical ­findings and was used to objectively assess the response to medical treatment.