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Corneal Endothelial Morphologic Features in Toxic Anterior Segment Syndrome

Avisar, Rahamim MD; Weinberger, Dov MD

doi: 10.1097/ICO.0b013e3181b11568
Clinical Science

Purpose: To investigate the clinical and laboratory findings of toxic anterior segment syndrome (TASS) following cataract surgery with intraocular lens (IOL) implantation, with emphasis on the morphologic features of the corneal endothelium.

Methods: A single-center retrospective observational case-control design was used. The sample consisted of 15 patients (mean age 60.3 ± 11.2 years) with a diagnosis of TASS following unilateral cataract surgery with IOL implantation. In all cases, cataract surgery with IOL implantation had already been performed in the fellow pseudophakic eye without complications. Data on the corneal endothelial morphologic features in both eyes were collected from the files as follows: endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells. Values in the eyes with TASS (study group) were compared with the fellow eyes (control group). Between-group differences were analyzed with Student's t test at a significance level of 5%.

Results: The eyes with TASS were characterized by a significantly lower endothelial cell density than the control eyes (2302 ± 220 cells/mm2 vs. 2853 ± 145 cells/mm2), higher mean cell area (coefficient of variation; 38 ± 1.4 vs. 24 ± 2.5), and lower mean percentage of hexagonal cells (22 ± 1.5% vs. 48 ± 3.2%; P < 0.01 for all). Common presenting symptoms and signs were blurred vision (60%), anterior segment inflammation (100%), and cell deposition (20%).

Conclusions: TASS following cataract surgery with intraocular lens implantation is associated with a low corneal endothelial cell density.

From the External Eye Disease Clinic, Department of Ophthalmology, Rabin Medical Center, Golda Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Received for publication August 5, 2008; revision received May 7, 2009; accepted June 1, 2009.

No author has a financial proprietary interest in any material or method mentioned.

Reprints: R. Avisar, MD, External Eye Disease Clinic, Department of Ophthalmology, Rabin Medical Center, Golda Campus, PO Box 121, Petah Tiqwa 49372, Israel (e-mail:

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