Corneal endothelial morphologic features in toxic anterior segment syndrome

Purpose: To investigate the clinical and laboratory findings of toxic anterior segment syndrome (TASS) following cataract surgery with intraocular lens (IOL) implantation, with emphasis on the morphologic features of the corneal endothelium. Methods: A single-center retrospective observational case-control design was used. The sample consisted of 15 patients (mean age 60.3 ± 11.2 years) with a diagnosis of TASS following unilateral cataract surgery with IOL implantation. In all cases, cataract surgery with IOL implantation had already been performed in the fellow pseudophakic eye without complications. Data on the corneal endothelial morphologic features in both eyes were collected from the files as follows: endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells. Values in the eyes with TASS (study group) were compared with the fellow eyes (control group). Between-group differences were analyzed with Student's t test at a significance level of 5%. Results: The eyes with TASS were characterized by a significantly lower endothelial cell density than the control eyes (2302 ± 220 cells/mm² vs. 2853 ± 145 cells/mm²), higher mean cell area (coefficient of variation; 38 ± 1.4 vs. 24 ± 2.5), and lower mean percentage of hexagonal cells (22 ± 1.5% vs. 48 ± 3.2%; P < 0.01 for all). Common presenting symptoms and signs were blurred vision (60%), anterior segment inflammation (100%), and cell deposition (20%). Conclusions: TASS following cataract surgery with intraocular lens implantation is associated with a low corneal endothelial cell density.