Toxic Anterior Segment Syndrome Associated With Immediate Preoperative Use of Besifloxacin

Monday, April 20, 2015: 4:11 PM
Room 1B (San Diego Convention Center)
S. Gregory Smith, MD

To determine the cause of TASS in our srugicenter associated with one surgeon out of 5.

Analysis of all procedural steps at the facility, on site investigation by ASCRS TASS consult group. With no definitive cause, immediate preoperative medications were analyzed.

Three cases of TASS were due to improper cleaning by new scrub tech.  After she was dismissed, the same surgeon continued to have events.  Further analysis revealed that surgeon one had 7 cases of TASS after the scrub tech was dismissed for a total of 10 cases in 120 surgeries.  He used besivance immediately preop.  Surgeon 2 had no cases in 122 surgeries over the same time at the same facility using besivance immediately postoperatively. Once besivance was discontinued  preoperatively, surgeon 1 had no episodes of tass in 70 cases.

Besivance immediately preoperatively but not immediately postoperatively appears to be associated with TASS.  The Durasite vehicle is probably the mechanism by which it is still on the surface during surgery.  The use of medications with the Durasite vehicle (besivance, durezol, azasite) immediately preoperatively is not recommended.