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46 | EYEWORLD DAILY NEWS | MAY 17, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING 13 eyes with elevated IOP, and six eyes with hyphema. In the study, IOL repo- sitioning or exchange was performed at a mean 8.1 months after diagnosis of UGH. Seven eyes had repositioning with scleral suturing, and in one eye, the IOL was reposi- tioned without sutures. Six eyes had an IOL exchange. Uveitis and hyphema resolved in all cases after IOL surgery, but recurrent vitreous hemorrhage in the periop- erative period necessitated vitreous lavage in one patient, Dr. Elhusseiny said. The mean BCVA improved after IOL re- positioning or exchange, with no difference between groups. Additionally, he said that the mean IOP was reduced at the final follow-up compared to preop, and the mean number of glaucoma medications was also reduced compared to preop. To view these and other presentations related to cat- aract surgery complications, search for SPS-208. Editors' note: Dr. Holland has financial interests with Alcon and Allergan. Dr. Cornell and Dr. Elhus- seiny have no financial interests related to their presentations. of unwanted optical aberra- tions with all lenses, including glare, halos, negative and positive dysphotopsias, and spiderweb effects. He added that 7.1% of patients had any optical aberrations in the study, including higher percentages of women (8.8%) than men (4.5%). He also said patient satisfaction with intraocular implant lenses is very high, and if patients are appropriately counseled before surgery about the possibility of unwanted optical side effects and offered an option to resolve this with a lens exchange, the majority of patients are happy with their results. Simon Holland, MD, Vancouver, Canada, present- ed on the topic of "Toxic Anterior Segment Syndrome Outbreak (TASS) Associated with Automatic Washers in 3 Canadian Clinics." The purpose of his study was to investigate TASS clusters in three clinics from 2018–2019 to identify any common factors. TASS outbreaks are difficult to inves- tigate due to multiple steps and products involved in reprocess- ing of instruments, and there are typically small sample siz- es. All clinics in the study used the same automatic washing Quick Rinse. In his study, 10 incident cases of TASS from three separate facilities were summarized using descriptive epidemiology. A chart review of 3:1 controls to cases was con- ducted to examine a variety of intraoperative exposures. Odds ratios for exposure variables, along with corresponding 95% confidence intervals and two- tailed Fisher's exact p-values were calculated. Additionally, site observations of the three implicated facilities were conducted, and fluid from the final wash from the automatic washer was tested using the LAL gel-clot test. The study results found that all clinics reported at least one case in the same week, with one clinic reporting all six cases on the same day. None of the exposures studied significantly influenced the risk of developing TASS at the 5% level of significance con- sistent with the small sample size. Additionally, observa- tional epidemiology showed that endotoxins detected from an automated flushing device (Quick Rinse) were a probable cause at all three clinics. Endotoxin was above recommended levels in dis- tilled water from the automatic washers in the three clinics. The clinics also made improve- ments to standard operating procedures for reprocessing in- struments in the same period. In conclusion, Dr. Holland's presentation noted that TASS outbreaks are often multifacto- rial, primarily related to issues with ophthalmic instrument re- processing. Endotoxin detected in a widely used, unregulated automated flushing device is of concern, he noted. Abdelrahman Elhus- seiny, MD, Miami, Florida, shared a paper on the surgical management of uveitis-glauco- ma-hyphema (UGH) syndrome. He began by noting that UGH syndrome was initially report- ed in the context of closed loop AC IOL haptics applying mechanical trauma to the adjacent iris tissue. This results in intraocular inflammation, hyphema, and elevated IOP, he said. Redesigned AC IOLs and the overwhelming prevalence of posterior chamber IOLs have greatly decreased the incidence of UGH syndrome, he added. However, Dr. Elhusseiny noted that new forms of UGH, which share many of the same clinical signs, can occur with AC and PCIOLs now in use. It's most commonly encountered in the context of a secondary glaucoma in an eye that evi- dences iris chafing by the IOL. Frank hyphema is uncommon, but CME, corneal decompen- sation, and elevated IOP may occur. He added that sulcus fixation should be avoided when possible to avoid UGH syndrome. The majority of cas- es cause minimal and transient symptoms that will resolve with topical steroids and anti-glaucoma medications. Dr. Elhusseiny suggested that IOL repositioning or exchange be considered for medially refractory UGH to reduce or eliminate the direct contact between the IOL and the uveal tissue. His study was a retrospec- tive chart review of patients with nUGH (newer form of UGH) who underwent IOL re- positioning or exchange by one surgeon. The study included 14 eyes with a mean age of 68.7 at the time of onset of UGH. Twelve PCIOLs (one that was iris fixated) and two AC IOLs were included. The median time from cataract extraction to onset of UGH was 7.5 years. The mean preoperative IOP was 26.4 mm Hg and mean glaucoma med- ications was 1.7. Additionally, Dr. Elhusseiny said four eyes had a pre-existing history of glaucoma, two of which had tube shunts. Clinical features included 13 eyes with uveitis, continued from page 44 Dr. Elhusseiny shares a case video of a patient who had a history of uveitis associated with the IOL rubbing the iris. Source: Abdelrahman Elhusseiny, MD, screenshot from presentation

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