Toxic Anterior Segment Syndrome Research Articles

Effectiveness of Intracameral Tissue Plasminogen (r-tPA) Activator in Resolution of Fibrinous Reaction in Refractory Toxic Anterior Segment Syndrome (TASS)

Purpose: To evaluate the effectiveness of tissue plasminogen activator (r-tPA) in resistant toxic anterior segment syndrome (TASS) after Phacoemulsification. Study Design: Quasi experimental. Place and Duration of Study: Khyber Teaching Hospital, Peshawar from August 2021 to August 2023. Methods: Forty-six patients (46 eyes) with an anterior chamber fibrin reaction after cataract surgery were treated with intra-cameral injection of t-PA (30µg/0.1cc) following failure to respond to conventional treatment with intensive topical and subconjunctival steroids. Outcome measures were best corrected visual acuity (BCVA), clearance/recurrence of the fibrin reaction and complications. Results: Intra-cameral t-PA was injected2 to 6 weeks post Phacoemulsification in TASS cases. Mean post-operative injection time was 18.5± 10.2 days. After 1st day post injection, we observed total abolition of fibrinous exudate in 36(78.2%) cases and subtotal resolution in 10 (21.7%) cases. After 6 weeks the TASS was completely settled in 43(93.4%)cases. Mean BCVA improved from 0.59 ± 0.40 log MAR pre-injection to 0.38 ± 0.40 log MAR at 6th week post-injection (p=0.07). There was no statistically significant difference in BCVA and rate of fibrinolysis between the two groups after post r-tPA injections. Intra-cameral r-tPA was not associated with adverse effects like raised IOP or endophthalmitis. Conclusion: Intra-cameral t-PA injection (30µg/0.1cc)appears to be a safe and effective treatment option for resolving anterior chamber fibrin reaction refractory to conventional steroid therapy following cataract surgery.

Outbreak of toxic anterior segment syndrome following vitreoretinal surgery - A retrospective analysis.

Toxic anterior segment syndrome (TASS) is an uncommon complication of vitreoretinal surgery and is characterized by severe anterior chamber reaction, hypopyon, and limbus-to-limbus corneal edema. Twenty-nine vitreoretinal surgeries were performed, of which 14 developed TASS in the early postoperative period. The operative records were reviewed retrospectively. The median age of patients was 49.07 ± 16.75 years and 14.28% of them were female. Also, 71.42% were operated in the left eye and 42.8% were pseudophakic. Recurrent retinal detachment, secondary scleral-fixating intraocular lens (SFIOL), and silicone oil removal (SOR) were the most common procedures. Severe anterior chamber reaction was seen in 14 patients, circumcorneal congestion in eight, corneal edema in 11 (78.6%), hypopyon in 13 (92.8%), and severe fibrin membrane in two patients. We describe the largest series of TASS following uneventful vitreoretinal surgery. Balanced salt solution was the instigating agent in this series. A prompt and thorough investigation is critical in obviating recurrences.

Causes and management strategies for elevated intraocular pressure after implantable collamer lens implantation.

With the widespread application of Implantable Collamer Lens (ICL) implantation surgery in the field of myopia correction, a comprehensive understanding of its potential complications, especially those related to intraocular pressure (IOP), becomes crucial. This article systematically reviews various complications that may lead to IOP elevation after ICL surgery. Firstly, common complications after ICL surgery, including residual viscoelastic, steroid response, and excessive vault of the ICL, are detailed, emphasizing their potential impact on intraocular pressure. Regarding residual viscoelastic, we delve into its direct relationship with postoperative elevated IOP and possible preventive measures. For steroid response, we stress the importance of timely adjustment of steroid therapy and monitoring intraocular pressure. Additionally, excessive vault of the ICL is considered a significant potential issue, and we elaborate on its mechanism and possible management methods. In further discussion, we focus on relatively rare complications such as Toxic Anterior Segment Syndrome (TASS), Urrets-Zavalia Syndrome (UZS), Pigment Dispersion Syndrome (PDS), and malignant glaucoma. For these relatively rare complications, this review thoroughly explores their potential mechanisms, emphasizes the importance of prevention, and provides guidance for early diagnosis and treatment. This is a comprehensible review that aims to offer eye care professionals a comprehensive understanding and effective management guidance for complications of elevated IOP after ICL surgery, ultimately providing optimal care for patients' visual health.

Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery – a case report

BackgroundIntraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis.Case presentationA 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200.ResultsThe retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved.ConclusionThis report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

Explantation of a light-adjustable intraocular lens: case report with laboratorial analyses

Introduction: A case in which a light-adjustable lens (LAL) underwent explantation and extensive laboratory analyses is reported. Patient and Clinical Findings: A 61-year-old man underwent uneventful cataract surgery with in-the-bag implantation of a first-generation LAL in the right eye. Examination on the second postoperative day revealed limbus-to-limbus corneal edema, moderate anterior chamber cells, and a mid-dilated, minimally responsive pupil, suggesting toxic anterior segment syndrome (TASS). Diagnosis, Intervention, and Outcomes: Endothelial keratoplasty was performed 2 months after LAL implantation. The patient reported noncompliance with required UV-protective eyewear, and an attempted light adjustment confirmed macromer reserve depletion, likely secondary to ambient UV contamination. Gross and microscopic examinations of the explanted LAL showed a decentered round elevation on the optic. The light transmittance (%T) curve was normal, with 95.9%T on average in the visible spectrum. Optical coherence tomography revealed irregular curvatures of the anterior and posterior optic surfaces. Wavefront analysis displayed aberrations and large power variations, which corresponded to decreased focus and contrast through the optic. Conclusions: To the authors' knowledge, this is the first reported case of LAL implantation complicated by TASS, leading to a prolonged clinical course and nonadherence to proprietary UV-protective spectacles. Extensive laboratory analyses of the explanted LAL demonstrated findings that can be expected with uncontrolled polymerization of the LAL.

ASCRS clinical advisory on intracameral moxifloxacin injection for infection prophylaxis.

Moxifloxacin solution is frequently injected at the conclusion of cataract surgery for endophthalmitis prophylaxis. 2 different concentrations are most commonly available in the United States for intracameral (IC) use: 0.5% (5 mg/mL) and 0.1% (1 mg/mL). The recommended volume to be injected is different for the 2 concentrations, and incorrect dosing can increase the risk of toxic anterior segment syndrome or endophthalmitis. In addition, the U.S. Food and Drug Administration recently published an alert regarding potential adverse events associated with intraocular compounded moxifloxacin. This clinical advisory reviews the optimal dosing of IC moxifloxacin based on current evidence.

Role of Prophylactic Oral Antibiotics in the Prevention of Post-cataract Surgery Acute Infective Endophthalmitis.

Purpose To evaluate the role of perioperative oral antibiotics in the prevention of acute infective endophthalmitis (IE) after cataract surgery. Methods A prospective cohort study of patients older than 18 years of age undergoing uncomplicated phacoemulsification was conducted. Group A was given post-op oral ciprofloxacin for three days, whereas Group B was not. Both groups received 5% povidone-iodine (PVI) preparation for five minutes in the conjunctival cul-de-sac, and intracameral (IC) 0.5% moxifloxacin was administered at the end of the procedure as prophylaxis. The minimum post-opfollow-up period was six weeks. Results Out of 2161 patients, 859 (39.8%) were included in Group A, and 1302 (60.2%) were included in Group B. No significant difference in anterior chamber (AC) reaction was found on day 1 (p = 0.67), day 14 (p = 0.03), or day 45(p = 0.1). One patient developed acute post-op IE (0.04%)and two patients developed toxic anterior segment syndrome (TASS) from Group A. The non-oral antibiotic group had no serious complications. Conclusion Perioperative oral antibiotic use in routine clinical practice is not recommended for the prevention of acute post-op IE. Pre-op conjunctival PVI 5% for five minutes and IC moxifloxacin at the end of surgery were proven to be effective prophylactic measures in our study.

CDC consultations related to ophthalmologic practices and settings, 2016–2021

Background: Healthcare activities that include instrumentation or manipulation of mucosal tissue or normally sterile sites, such as the eye and its associated structures, place patients at risk of infectious and other complications. We reviewed queries to the CDC Prevention and Response Branch that were focused on ophthalmologic procedures and settings to examine opportunities to improve infection prevention and control (IPC) practices in these settings. Methods: We reviewed internal CDC consultation records received from January 1, 2016, through December 31, 2021, to identify those involving ophthalmologic procedures or settings. Consultations were reviewed to determine setting type, number of patients affected, organisms identified, nature of infection control breaches, and whether medical products were implicated. Descriptive statistics were calculated. Results: We identified 24 consultations among 19 states and US territories. Of these, 21 (87.5%) involved outpatient settings, of which 9 (43%) were ambulatory surgery centers. Consultations included the following non–mutually exclusive categories. There were 18 adverse postsurgical events (75%), such as mycobacterial infection after laser surgery and toxic anterior segment syndrome following cataract surgery (n = 5). There were 11 infections following ophthalmologic clinical care (46%), such as epidemic keratoconjunctivitis due to adenovirus 8. There were 8 suspected medication-related events (33%) including contamination of ophthalmic medication when manufactured or compounded offsite. There were 8 medical-device reprocessing concerns (33%) including inappropriate high-level disinfection. There were 8 instances of improper environmental cleaning and disinfection (33%), for example, during an adenovirus outbreak. There were 3 cases of potential mishandling of medications onsite (12.5%), such as multiuse eye drops. Also, 3 events (12.5%) were associated with potentially contaminated donor tissue, such as corneas for transplantation. When a consultation included identification of a pathogen (n = 11), organisms included bacteria (n = 7, 64%), viruses (n = 2, 18%), and fungi (n = 3, 27%). In total, 202 patients had confirmed ophthalmologic infections or adverse events. Conclusions: Based on our review of recent outbreaks, healthcare personnel in ophthalmologic settings may have deficits in training related to instrument reprocessing and environmental cleaning specific to ophthalmic equipment and settings that can result in harm to patients. These settings could benefit from targeted training to improve IPC practices specific to ophthalmologic examinations and procedures. This review was limited to analysis of investigations that were voluntarily reported to the CDC. A formal surveillance system for adverse outcomes in this setting could clarify the nature and frequency of IPC issues of greatest concern.Disclosures: None

Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic

To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

Identification and management of a toxic anterior segment syndrome hospital cluster

Identification and management of a toxic anterior segment syndrome hospital cluster

Immediate Sequential Bilateral Surgery in Refractive Lens Exchange Patients: Clinical Outcomes and Adverse Events

To evaluate outcomes and the incidence of adverse events (AEs) in patients who underwent bilateral same-day refractive lens exchange (RLE). Retrospective case series. Patients of a private intraocular surgery provider in the United Kingdom who underwent RLE in both eyes on the same day with treatment dates between March 2018 and December2021. Clinical outcomes and AEs were collected for a continuous cohort of patients undergoing bilateral same-day RLE (in the absence of visually significant cataracts) or had mild cataracts (corrected visual acuity ≥ 20/40). One-month clinical outcomes were analyzed. Refractive outcomes and visual acuity, intraoperative and postoperative AEs, and secondary surgical interventions recorded within the first month after surgery. A total of 17 330 patients (34 660 eyes) were included in the analysis. Of these, 28 827 eyes received a multifocal intraocular lens (IOL), and 5833 eyes had a monofocal IOL. The percentage of eyes within ±0.50 diopters (D) of intended refraction was 85.5% and 86.2% for monofocal and multifocal IOL eyes, respectively. There was a total of 55 intraoperative AEs recorded in 55 eyes of 54 patients (per-eye incidence: 0.159%). Posterior capsule tear was the most common intraoperative event occurring in 37 eyes (0.107%). The number of AEs recorded within the first postoperative month was 267, occurring in 263 eyes of 177 patients (per-eye incidence: 0.759%). These included cystoid macular edema (CME) (172 eyes; 0.496%), significant corneal edema (28 eyes; 0.081%), persistent inflammation (27 eyes; 0.078%), significantly raised intraocular pressure (27 eyes; 0.078%), toxic anterior segment syndrome (8 eyes; 0.023%), wound leak (3 eyes; 0.009%), retinal detachment (1eye; 0.003%), and retinal tear (1 eye; 0.003%). There were 56 secondary surgical interventions recorded within the first month of surgery, occurring in 54 eyes of 47 patients (per-eye incidence: 0.156%). The most common secondary intervention was the rotation of a misaligned toric IOL (24 eyes; 0.069%). Elective same-day bilateral RLE had a low incidence of serious AEs, and high refractive predictability. Proprietary or commercial disclosure may be found after the references.

Late-onset toxic anterior segment syndrome after ICL implantation: two case reports

BackgroundToxic anterior segment syndrome (TASS) is a non-infectious inflammation that can occur after any anterior segment procedure. This case report presents two relatively rare late-onset TASS cases after V4c implantable collamer lens (ICL) operation.Case presentationOne 25-year-old woman and one 31-year-old woman suddenly had vision loss in monocular for 1 week after biocular V4c ICL operations and with no subjective complaints. They both presented fibrin formation in the anterior chamber such as keratic precipitates and white pus on the surface of the ICL. Fundus examination was normal. After 4 to 5 weeks of topical and oral steroid treatment, visual acuity and fibrin formation in the anterior chamber improved during the follow-up.ConclusionsTASS should be suspected in any patient during the late period following ICL surgery; Once TASS is diagnosed, adequate treatment with intensive steroid therapy can be implemented.

Intracameral Drug Delivery: A Review of Agents, Indications, and Outcomes.

An intracameral (IC) injection directly delivers the drug into the anterior chamber of the eye. This targeted drug delivery technique overcomes the ocular barriers and offers a high therapeutic concentration of medication at the desired site and consequently better clinical outcomes. IC drug delivery is a safe and effective modality with many advantages over topical delivery. These include excellent bioavailability, reduced systemic risk, and minimal ocular toxicity. Agents delivered via IC injection have shown promising results against infection, inflammation, ocular hypertension, and neovascularization. Current literature shows that IC antibiotics, including cefuroxime, vancomycin, and moxifloxacin, are routinely used for prophylaxis of endophthalmitis. Other drugs available for IC use are steroids, anesthetics, mydriatics, miotics, antivascular endothelial growth factor, antiglaucoma, and alkylating agents. Introduction of sustained-release devices containing dexamethasone or Bimatoprost in anterior chamber via IC route has the potential in treating ocular inflammation and raised intraocular pressure. The complications such as hemorrhagic occlusive retinal vasculitis and toxic anterior segment syndrome have been documented with IC prophylaxis but are rare. In this review, we provide an overview of available IC drugs, their pharmacokinetics, the spectrum of activity, dosage and preparation, prophylactic and therapeutic usage, clinical efficacy, and safety profiles.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

Commentary: Blockchain technology and its current importance in toxic anterior segment syndrome outbreak in India.

Toxic anterior segment syndrome and Urrets-Zavalia syndrome: Spectrum of the same entity?

The purpose of the study was to analyze the outcomes of patients with toxic anterior segment syndrome (TASS) and Urrets-Zavalia (UZ) syndrome. The records of all patients with TASS and UZ syndrome were studied. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), and the details of surgeries performed were recorded at 1 and 3 months. We studied the changes in CDVA and IOP using repeated-measure ANOVA and paired t -test, respectively. Four patients (44.4%) developed refractory UZ syndrome, and five (55.6%) patients had TASS. At the end of 3 months of follow-up, all nine patients had concentric rings of iris atrophy and corneal edema. None of the cases had hypopyon or vitritis. Peripheral anterior synechiae (PAS) with secondary glaucoma was present only in cases of UZ syndrome. Among the four cases of UZ syndrome, goniosynechialysis was performed for 2 cases and trabeculectomy for one case. Despite these interventions, IOP could not be controlled. Patients in the TASS group did not exhibit PAS formation, and IOP was normal, but corneal edema and concentric rings of iris atrophy persisted. Descemet's stripping endothelial keratoplasty was performed for all the TASS cases. There was a statistically significant drop in CDVA (P = 0.028) and an increase in IOP (P = 0.029) at 3-month postcataract surgery. TASS and UZ syndrome could result in sight-threatening complications. They may be considered diseases of the same entity as both the conditions were found in the same cluster. TASS could be considered as an abortive attack of UZ syndrome.

Immediate sequential bilateral cataract surgery: a review of current practice and literature

Immediate Sequential Bilateral Cataract Surgery (ISBCS) is a type of cataract surgery in which the eyes of patients with bilateral cataracts are operated on in the same setting, in contrast to the current standard of care, Delayed Sequential Bilateral Cataract Surgery (DSBCS), where only one eye is operated on and followed by the other eye at a later date. ISBCS carries benefits such as cost-efficiency and a lower risk of general anesthesia complications in certain patient populations, but also includes disadvantages such as the potential of developing bilateral endophthalmitis, toxic anterior segment syndrome (TASS) and unpredictable refractive outcomes. The goal of this article is to provide a review of the current knowledge and literature about ISBSC, mainly reviewing current guidelines, criteria for patient selection, advantages, disadvantages, complications, and where it stands in comparison to the current standard of care.

Синдром токсического поражения переднего сегмента глаза (tass) после факоэмульсификации катаракты и имплантации иол. (клинический случай)

Purpose.To present a clinical case of TASS at the IRTСEye Microsurgery Ekaterinburg center. Clinical case. Patient C, born in 1955 came to the Center in 2016 with complaints of low vision in the left eye. After a standard ophthalmologic exa mination, she was diagnosed with mature cataract with elements of swelling in the left eye, initial cataract, 1st degree hyperopia in the right eye. Phacoemulsification of cataract with IOL implantation was suggested for the left eye. The patient developed TASS-syndrome the next day after the surgery. Results. We have analyzed possible causes of TASS development in the patient. The peculiarity of the operative treatment was the use of Rhex-ID capsule dye in the volume of 1 ml. We assumed that the use of this dye was the cause of the syndrome. Conclusion. The problem of postoperative inflammatory reaction remains rather urgent despite of rare occurrence of toxic anterior segment syndrome. The syndrome appears suddenly and unpredictably, can take the form of an outbreak in an individual institution. TASS is a condition similar to infectious bacterial postoperative complications in its clinical manifestations and presence of pathognomonic symptoms, which complicates diagnosis and determination of tactic. Key words: TASS; toxic anterior segment syndrome; postoperative endophthalmitis.

Molecular and microbiological evidence of bacterial contamination of intraocular lenses commonly used in canine cataract surgery.

Inflammatory outcomes, including toxic anterior segment syndrome (TASS) and infectious endophthalmitis, are potentially painful, blinding complications following cataract surgery. In an in vitro pilot study, commercially available, sterile foldable intraocular lenses (IOLs) used during routine canine cataract surgery, and their packaging fluid were surveyed for the presence of bacterial DNA and/or viable (cultivable) bacteria. Swabs from IOLs and packaging fluid from three different veterinary manufacturers and three different production lots/manufacturer were collected for 16S ribosomal ribonucleic acid (rRNA) sequencing. Packaging fluid samples were collected for aerobic/capnophilic bacterial culture. Culture yielded one isolate, identified as Staphylococcus epidermidis. 16S rRNA sequencing revealed distinct brand-specific bacterial DNA profiles, conserved between IOLs and packaging fluid of all production lots within each manufacturer. The dominant taxonomy differentiating each manufacturer was annotated as Staphylococcus sp, and was a 100% match to S. epidermidis. Distinct mixtures of bacterial DNA are present and consistent in IOLs and packaging fluid depending on the manufacturer, and Staphylococcus is the dominant contributor to the bacterial DNA detected. Caralens products had a significantly lower amount of Staphylococcus spp. compared to Anvision and Dioptrix products.

Impact on corneal morphology after cataract surgery with intracameral moxifloxacin in neglected hard cataracts.

To evaluate corneal morphology after use of 0.5% intracameral moxifloxacin (ICM) in cataract surgery in patients who presented late with hard cataracts. Cross-sectional study conducted from June-2021 to December-2021 at a tertiary eye-care center. 90 patients over 60 years with high-risk characteristics for Covid-19, who presented late with higher grades of nuclear-sclerosis (NS), were included. They underwent phacoemulsification and 0.5%moxifloxacin (0.1 ml) was injected intracamerally at the end of surgery. Best-corrected visual acuity (BCVA), intraocular pressures (IOP), endothelial cell density (ECD), coefficient of variation in cell-area (CoV), hexagonality (Hex) and central corneal thickness (CCT) were measured preoperatively and postoperatively on day1, day7 and day30. Statistical analysis was done by Anova test. p-value<0.05 was considered significant. Mean age of presentation was 65.26±8.3 years. Mean preoperative BCVA (1/60-to-6/60), IOP (16.7±2.3 mm of Hg), CCT (523.93±39.6µ), ECD (2547±302.08cells/mm2), Hex (47.04±5.7%) and CoV (37.57±3.9) changed to BCVA (6/9-to-6/6), IOP (17.5±2.1 mm of Hg), CCT (538.42±36.9µ), ECD (2388.40±339.25cells/mm2), Hex (44.44±5.6%) and CoV (39.09±4.5) at day30 postoperative. Average rate of change at day30 was increase in CCT (2.89%), ECD loss (6.4%), decrease in Hex (4.9%) and increase in CoV (4.6%), though clinically insignificant. No case of endophthalmitis or toxic-anterior segment syndrome seen. 0.5% moxifloxacin (0.1 ml) is safe as intracameral antibiotic to prevent postoperative infection in high-risk patients. The reported changes in the corneal parameters were within the range of any routine surgeries of hard senile cataracts. No specific effect could be attributed to ICM.