Impact of Indocyanine Green Concentration, Exposure Time, and Degree of Dissolution in Creating Toxic Anterior Segment Syndrome: Evaluation in a Rabbit Model.

Tamer Tandogan,Ramin Khoramnia,Michael Janusz Koss,Gerd Uwe Auffarth,Chul Young Choi

doi:10.1155/2016/3827050

Abstract

Purpose. To investigate the role of indocyanine green (ICG) dye as a causative material of toxic anterior segment syndrome (TASS) in an experimental rabbit model. Method. Eight eyes of four rabbits were allocated to this study. Capsular staining was performed using ICG dye, after which the anterior chamber was irrigated with a balanced salt solution. The effects of different concentrations (control, 0.25, 0.5, and 1.0%), exposure times (10 and 60 seconds), and the degree of dissolution (differently vortexed) were investigated. The analysis involved anterior segment photography, ultrasound pachymetry, prostaglandin assay (PGE2 Parameter Assay, R&D systems, Inc.), and scanning electron microscopy of each iris. Result. There was no reaction in the control eye. A higher aqueous level of PGE2 and more severe inflammatory reaction were observed in cases of eyes with higher concentration, longer exposure time, and poorly dissolved dye. Additionally, scanning electron microscopy revealed larger and coarser ICG particles. Conclusion. TASS occurrence may be associated with the concentration, exposure time, and degree of dissolution of ICG dye during cataract surgery.

Highlights

Toxic anterior segment syndrome (TASS), an acute, noninfectious inflammation of the anterior segment of the eye, is a complication of anterior segment eye surgery, such as cataract extraction surgery
There are several previous studies dealing with the safety and efficacy of indocyanine green (ICG) dye for capsular staining in cataract surgery [10, 11]
Fibrous membrane formation was more prominent in the right eye of Rabbit Number Two, which was exposed to ICG for a longer time than left eye with shorter exposure time (Figure 3)

Summary

Introduction

Toxic anterior segment syndrome (TASS), an acute, noninfectious inflammation of the anterior segment of the eye, is a complication of anterior segment eye surgery, such as cataract extraction surgery. Since 2000, there have been several reports of varying degrees of anterior segment damage from toxic substances after cataract surgery; some of these events had the appearance of an outbreak [2,3,4,5,6]. This led to the formation of the TASS task force, and the American Society of Cataract and Refractive Surgery (ASCRS) task force team reported 367 cases of TASS with multiple potential causative factors in 2010 [7]. Most cases of TASS can be treated successfully with topical steroids, topical nonsteroidal anti-inflammatory agents, or both, the inflammatory response associated with TASS can cause serious damage to intraocular tissues, resulting in vision loss [8, 9]

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