Reply : Late-onset toxic anterior segment syndrome after possible aluminum-contaminated and silicon-contaminated intraocular lens implantation.

PURPOSE:To describe an outbreak of late-onset toxic anterior segment syndrome (TASS) after the implantation of a specific hydrophilic acrylic intraocular lens (IOL). SETTING:University Hospitals of Leuven, Belgium. DESIGN:Retrospective, single-center, observational study. METHODS:All eyes undergoing cataract surgery with a monofocal, toric, or enhanced depth-of-focus (EDoF) Synthesis (Cutting Edge) IOL between August 2019 and March 2020 were reviewed. Data were collected on the surgical procedure, postoperative course, time until onset of symptoms, clinical features, and additional treatments. A laboratory surface analysis of all 3 IOL subtypes was performed in the Intermountain Ocular Research Center at the University of Utah, USA. Furthermore, other possible causes of prolonged postoperative inflammation rather than the IOL itself were investigated. RESULTS:Among the 203 eyes included, 28 TASS cases were identified (13.8%), among which 25 received a monofocal IOL, and 3 received an EDoF IOL. The mean time until onset was 28.9 (±19.9) days. Patients presented with anterior chamber cells (92.9%), deposits on the IOL (57.1%), or fibrinous inflammation (35.7%). 4 eyes (14.3%) underwent a surgical intervention, whereas 24 eyes showed a resolution of inflammation with topical therapy alone. Laboratory analysis showed the presence of both aluminum and silicon particles on the monofocal IOL, silicon particles only on the EDoF IOL, and no particles on the toric IOL surface. CONCLUSIONS:This report describes an outbreak of atypical, late-onset TASS after cataract surgery, possibly correlated with aluminum and silicon contamination of the IOL surfaces.