ROOM SERVICE Flush instruments immediately after use to prevent bioburden from drying on surfaces.

Toxic anterior segment syndrome (TASS) is an acute inflammatory response in the eye's anterior chamber that can strike after cataract surgery. Large outbreaks of TASS are on the decline, and no major outbreaks have been tied to a particular product, medication or IOL. But incidences are still occurring at individual surgical facilities, which indicates there's still work to be done at preventing the avoidable complication. Here are answers to questions you might have.

Q Eye instruments are different from other surgical instrumentation. What factor does that play in TASS?

A Even a minute amount of enzyme or detergent left on surfaces of instruments can cause toxicity in the eye, where elsewhere in the body it wouldn't have significant impact. After eye surgery, very little tissue is left on instruments, and you can remove what's there with adequate manual cleaning and thorough flushing. We found that eye specialty centers are generally more attuned to potential TASS risk factors than multispecialty surgical facilities, which tend to treat all instruments the same — reprocessing with enzymes, ultrasound and detergents — instead of managing eye instrument trays separately.

Q How should we perform the final rinse?

A It's recommended that you flush irrigation/aspiration and phaco handpieces with distilled or deionized water for the final rinse.

Q What about using enzymatic detergents during instrument reprocessing?

A Enzymes and detergents aren't needed to decrease bioburden buildup, but some ophthalmic manufacturers still recommend the practice.

Q Do you recommend disposable cannulas?

A Yes. More facilities are opting to use disposable cannulas. This eliminates the possibility of injecting eyes with viscoelastic solution remaining on reusable cannulas that aren't properly flushed at the point of care.

Q What do we need to keep in mind if we add epinephrine to BSS solution to keep pupils dilated?

A If your surgeons are using epinephrine to dilate pupils, make sure the solution is adequately diluted, even if it's labeled preservative-free. Of course, we recommend that you use preservative-free epinephrine, but it's becoming increasingly difficult to find such solutions. Epinephrine solutions that contain sodium bisulfate as stabilizing agents are becoming more popular. Technically, these solutions are preservative-free, but high doses of sodium bisulfate can cause issues in the eye's anterior chamber.

HANDS OFF Use proper instruments to load implants in lens injector systems.

Q Should we put eye instruments through an ultrasound bath?

A There's been an increased use of ultrasound baths to clean instruments that haven't been properly flushed and aspirated. However, ophthalmic instruments that have been manually cleaned and rinsed don't need to go through an ultrasound cycle, which contains enzymes and detergents that increase TASS risks when they remain on devices, and ultimately aren't needed to remove the minimal amounts of bioburden left on ophthalmic instruments after surgery. If you still choose to run ophthalmic instruments through an ultrasound bath, make sure you drain and clean the bath after each use. Many centers are simply cleaning baths at the end of they day, which isn't acceptable.

Q Is it okay to touch intraocular lenses and the tips of instruments that go into the eye with gloved hands?

A No. Even the surfaces of powder-free gloves contain trace amounts of the releasing compound material used to get the gloves off molds during production. That material could cause inflammation in the anterior chamber if it comes in contact with IOLs placed in the eye. The bottom line: Use proper instruments — not the finger or thumb of a gloved hand — when loading implants in lens injector systems.

Stay vigilant
Greater awareness and improved practices have decreased TASS outbreaks, but don't let your guard down. It's when you stop paying adequate attention to the basic precautions, especially those related to the proper cleaning and flushing of instruments, that you'll run into issues with the complication so many centers are striving to eliminate.