Four Cases of Toxic Anterior Syndrome after Cataract Surgery under Intracameral 0.5% Lidocaine Anesthesia

Abstract

Purpose: To report four cases of toxic anterior segment syndrome after cataract surgery under intracameral 0.5% lidocaine anesthesia.Case summary: Four patients had a decrease in visual acuity within 3 days of undergoing cataract surgery. There was evidence of anterior chamber inflammation with corneal edema and opacity. Toxic anterior segment syndrome was diagnosed on the basis of negative microbial cultures and clinical features. Three patients were treated with systemic and topical steroids, and one was treated with topical steroids only. Three months postoperatively, three patients had good visual acuity without inflammation or corneal edema. However, one patient, who did not receive systemic steroids, exhibited persistent corneal edema and required endothelial keratoplasty.Conclusions: Toxic anterior segment syndrome is a surgical complication that requires immediate treatment. Systemic steroids can be helpful with topical steroids. Clinicians should ensure that measures are taken to avoid contamination of surgical procedure with toxic substances to prevent toxic anterior segment syndrome.