The number of centers reporting cases of TASS from February through May of 2006 now numbers more than 100. Nick Mamalis, MD, professor of ophthalmology at the University of Utah said that while there is no specifically recognized cause, the following factors may be related to the outbreak:
- Preoperative use of nonsteroidal anti-inflammatories (NSAIDs).
- Intracameral anesthetics.
- Epinephrine added to BSS solutions.
- Intracameral antibiotics, if improperly dosed, mixed, or injected into the eye.
- Reusable cannulas may allow a residue of OVD, cortex or other materials that can be toxic when injected into the anterior chamber.
- A majority of IOLs reported were Alcon lenses. But given Alcon's large market share, it's unclear if this represents an association with the outbreak.
- Not allowing enough time to process and properly clean instruments. Ultrasound baths, enzymes and detergents can cause problems if materials are not properly flushed from instruments, cannulas and hand pieces. Rinsing in sterile deionized water is important. An alcohol rinse will remove endotoxin following ultrasound baths.
A more complete review of this analysis of reports from 39 centers and 16 surgeons can be found on the American Academy of Ophthalmology Web site.
This analysis is ongoing. Suspicious outbreaks should be reported to Nick Mamalis, MD, professor of ophthalmology at the University of Utah: nick.mamalis@hsc.utah.edu; phone, 801.581.6586 or fax 801.581.3357. Or contact the Center for Disease Control at: CDC, Division of Health Care Quality Promotion, 1.800.893.0485.
ASORN will be conducting a survery regarding TASS in the near future.