In June, a 3M study published in Healthcare Purchasing News drew attention to the phenomenon of Toxic Anterior Segment Syndrome (TASS). This condition is also known as toxic endothelial cell destruction. It has been associated with sterilization residue in many cases where cataract eye surgery has failed.

The problem arises when a non-infectious inflammation occurs after an uneventful eye surgery.  Sometimes, there is no complication at all during the surgery itself and there is every indication that the operation was successful. However, the procedure may ultimately fail because of the onset of TASS.

This is a serious post-procedure complication that generally requires additional surgeries to correct. Prevention is obviously the preferable choice. The eye is one of the most sensitive organs in the human body.  There is simply not much room for error.

Over 3.1 million cataract procedures were performed in 2006 on an outpatient basis in the US.  100 different North American eye clinics reported incidents of TASS within a 4 month period that year. Although 90 to 95 percent of all cataract surgeries are successful, new data suggests that this percentage could be increased with better sterilization practices.

What Causes TASS?

A number of different chemicals have been identified that may cause TASS. These can be left behind on instruments even after a regular sterilization cycle. Higher standards may be required to prevent contamination with such residues when dealing with items that will be used for eye surgery.

In 2000, gas plasma sterilization was responsible for the degradation of brass-containing instruments that were later found to be the source of a TASS outbreak.  In 2006, affected corneas on six different Turkish patients failed to heal.  More surgery was required for each individual.  The cause of this TASS outbreak was identified as the use of cold sterilization with 2% glutaraldehyde inside the operating room. This information was later published byThe American Society of Cataract and Refractory Surgery and the Association for the Advancement of Medical Instrumentation.

There have been many other TASS outbreaks throughout the U.S. and the world reported from various sources. These events implicate improper sterilization procedures or poorly maintained autoclaves. Unfortunately, data concerning this problem and its specific cause in each case is inadequate.  Most of the data available has been identified because of voluntary reporting of significant incidents.  Better studies on this topic are needed in the near future.

TASS awareness is important. The syndrome has seen a significant increase in occurrence since 2005. Information about this growing problem must be shared by all the professionals in the eye surgery field.  Accurate record keeping is absolutely essential for the identification of potential sterilization problems and the implementation of procedural solutions.

Sterilization Concerns

Most often these cases of TASS are associated with not following manufacturer’s recommendation in handling of instruments during sterilization.  Approved methods for rinsing off the items should reduce the risk of contamination.  Many problems occur when supply inventories are low and there is inadequate time for proper cleaning. The following guidelines should be adhered to:

  • Flash sterilization should not be used for eye surgery instruments.
  • Low temperature sterilization must be an approved cleaning method per the manufacturer’s recommendations for each instrument.
  • Glutaraldehyde is not recommended for use with eye surgery instrumentation.
  • Routine verification of sterilizer function must occur (at least weekly, preferable daily).

Reliability of equipment is just as important as proper use. Sterilizers and autoclaves need to be certified to handle the instrumentation that they will reprocess.  Valuable information about selecting the right autoclave is just a click away in this free report.