Evaluation of the effect of vitreomacular interface disorders on anti-VEGF treatment in patients with diabetic macular edema in real life: MARMASIA study group report No. 10.

PURPOSE: The aim of this study is to investigate the effect of vitreomacular interface disorders (VMID) on treatment response in patients treated with anti-vascular endothelial growth factor (anti-VEGF) due to diabetic macular edema (DME). METHODS: Three hundred seventy-seven eyes of 239 patients in the MARMASIA Study Group who received intravitreal anti-VEGF treatment (IVT) due to DME were included in the study. The group 1 consisted of 44 eyes of the patients who had not received any treatment before, were followed up regularly for 24 months after at least a 3-month loading dose, and suffered from VMID such as epiretinal membrane, vitreomacular adhesion or traction, and lamellar hole. The group 2 consisted of 333 eyes of the patients without VMID. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients at baseline, 3rd month, 6th month, 1st year and 2nd year follow-ups were measured. RESULTS: The mean age of the Groups 1 and 2 was 67.1 ± 11.3 and 61.9 ± 10.2 years, respectively. 61.3% of the group 1 and 58.8% of the group 2 were female (p > 0.05). The duration of diabetes was 19.2 ± 3.7 and 15.8 ± 3.2 years, respectively, and the number of follow-ups was 16.09 ± 4.68 and 12.06 ± 4.58, respectively in the groups (p < 0.001, 0.001, respectively). The number of IVT was 7.13 ± 2.71 and 7.20 ± 2.22, respectively in the groups 1 and 2 and no statistically significant difference was observed between them (p = 0.860). According to logMAR, BCVA values at baseline were 0.63 ± 0.24 and 0.59 ± 0.26 (p = 0.29), respectively, in the groups and the amount of change in BCVA at the end of the 2nd year was - 0.02 ± 0.48 in the group 1 and - 0.12 ± 0.48 in the group 2. It was observed as 0.48 (p = 0.13). Although the increase in BCVA was greater at all follow-ups in the group 2 compared to their initial examination, no significant difference was observed between the groups in terms of BCVA change. The CMT values of the groups at baseline were 442.5 ± 131.3 µm and 590.9 ± 170.6 µm, respectively (p = 0.03) The decrease in CMT after IVT was significantly greater in the group 2 at all follow-ups when compared to the first group (p < 0.05). CONCLUSION: While the presence of VMID in DME patients receiving IVT did not affect visual results, it negatively affected the anatomical response and macular edema morphology. The presence of VMID at baseline affected the success of IVT. It should be taken into consideration that VMID may resolve spontaneously or with IVT, and new cases of VMID may occur in patients during the treatment process.

Efficacy of ranibizumab and aflibercept on reducing maximum diameter of largest cyst in diabetic cystoid macular edema: MARMASIA study group.

PURPOSE: This study aimed to compare the effect of intravitreal aflibercept (IVA) and ranibizumab (IVR) on the maximal diameter of the largest intraretinal cyst (mdIRC), indicating chronicity in patients with diabetic cystoid macular edema (CME). METHODS: This retrospective, comparative study included a subgroup of patients from the MARMASIA Study with treatment-naïve diabetic CME who had IVA (IVA group) or IVR (IVR group) on a pro re nata regimen after a loading dose of 3-monthly injections and followed-up for 24 months. Best-corrected visual acuity (logMAR), central macular thickness (CMT, µm), and mdIRC (µm) and their changes during the study period in the IVA and IVR groups were compared. RESULTS: A total of 175 eyes (65 [37.1%] in IVA and 110 [62.9%] in IVR group) of 113 patients were included in the study analysis. Both groups had statistically significant improvements in BCVA and CMT during the follow-up (p < 0.05 for all), which were comparable between the groups at each time point. However, the mean reduction in mdIRCs was consistently and significantly higher in the IVA group compared to the IVR group at each follow-up examination (F[1, 3.52] = 6.93, p = 0.009). CONCLUSION: IVA seems to have a greater impact in reducing cyst sizes than IVR in diabetic CME.

One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13.

PURPOSE: To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. METHODS: In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. RESULTS: 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). CONCLUSIONS: In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.

Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1.

Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, µm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 µm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 µm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion: This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.

Efficacy of Simultaneous Application of Subretinal Tissue Plasminogen Activator and Bevacizumab for Submacular Hemorrhages.

Objectives: The aim of the study was to evaluate the patients who received simultaneous subretinal tissue plasminogen activator (tPA) and bevacizumab for submacular hemorrhages secondary to neovascular age-related macular degeneration. Methods: This retrospective study included patients who underwent pars plana vitrectomy (PPV) with simultaneous subretinal tPA and subretinal bevacizumab with 18% SF6 tamponade. Anatomical and functional results of the patients before surgery and at the 1st, 6th, and 12th months after surgery, additional treatments, and complications after PPV were evaluated. Results: Eight eyes of eight patients were included in the study. The mean age of the patients was 72.38±92.3. The mean time from the onset of symptoms to treatment was 5.13±1.88 days. The patients' mean best-corrected visual acuity (BCVA) was 2.23±0.14 logMAR at baseline. Mean BCVA increased significantly at 1st, 6th, and 12th months to 1.68±0.47 logMAR, 1.58±0.49 logMAR, and 1.51±0.58 logMAR, respectively (p=0.001 at all). The mean central foveal thickness (CFT) in measurable patients was 836.8±627.02 µm at baseline. Mean CFT decreased significantly to 370.13±66.13 µm in the 1st month, 373.38±78.33 µm in the 6th month, and 367.75±116.43 µm in the 12th month (p<0.05). The maximum measurable subretinal hemorrhage height at baseline was 814.2±556.45 µm. The mean number of anti-VEGFs performed for 12 months after surgery was 4.13±2.1. At month 12, the ellipsoid zone could not be detected in 6 (75%) patients. Conclusion: Administration of subretinal bevacizumab and subretinal tPA effectively removes subretinal hemorrhage under the fovea. Intravitreal anti-VEGF treatment must be continued, as choroidal neovascular membrane activity continues after surgery.

Effects of fluorescein on corneal endothelial morphology after fundus fluorescein angiography in patients with diabetic macular edema.

PURPOSE: To evaluate the effects of fluorescein dye on corneal endothelial morphology (CEM) after fundus fluorescein angiography (FFA) in patients with diabetic macular edema (DME). METHODS: In this retrospective study, patients were divided into two groups, nonproliferative diabetic retinopathy (Group-1, NPDR) and proliferative diabetic retinopathy (Group-2, PDR). CEM properties including endothelial cell density (ECD), coefficient of variation of cell area (CV), average cell area (AVG), percentage of hexagonal cells (HEX), and central corneal thickness (CCT) were measured before FFA and at week 1 and month 1 after FFA were collected from patients' charts. RESULTS: The study consisted of 48 patient's 48 eyes in Group-1 and 50 patient's 50 eyes in Group-2. In both groups, the mean ECD, CV, AVG, HEX, and CCT measurements at week 1 and month 1 after FFA did not differ statistically from the mean measurements before FFA (p > 0.05). The mean ECD measurements in Group-1 were higher than that in Group-2 and showed statistically significant differences among the groups (p < 0.01 for all). In the Pearson correlation analysis in Group-1, there was no statistically significant relationship between best-corrected visual acuity (BCVA) and (intraocular pressure) IOP values and ECD, AVG, CV, HEX, and CCT measurements (except central macular thickness [CMT] and HEX) before FFA, at week 1 and month 1 after FFA (p > 0.05). In Group-2 there was no statistically significant relationship between BCVA, IOP, and CMT measurements and ECD, AVG, CV, HEX, and CCT measurements before FFA, at week 1 and month 1 after FFA (p > 0.05). CONCLUSIONS: There is no significant change in CEM after FFA in patients with NPDR and PDR with DME.

Protective effects of melatonin receptor agonists on endotoxin-induced uveitis in rats.

Objectives: Melatonin has an important role in regulating a variety of physiological functions of the body. We investigated the protective effects of Agomelatine (AGO) and Ramelteon (RAME) on Endotoxin-Induced Uveitis (EIU) in rats. Materials and Methods: 70 rats were randomly divided into fourteen groups. Healthy group normal saline, (IP), Uveitis group (200 µg/kg lipopolysaccharide (LPS), SC), DEX group (200 µg/kg LPS plus 1 mg/kg dexamethasone, IP), AGO20 group received 200 µg/kg LPS plus 20 mg/kg AGO, AGO40 group received 200 µg/kg LPS plus 40 mg/kg AGO, RAME2 group received 200 µg/kg LPS plus 2 mg/kg RAME, and group RAME4 received 200 µg/kg LPS plus 4 mg/kg RAME. Each group had two subgroups: the 3rd and 24th hr. The eye tissues were collected and investigated biomicroscopically (clinical manifestations and scoring, molecularly(qRT-PCR analyses of tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and caspase 3 and caspase 9 mRNA expression), biochemically (Superoxide dismutase activity (SOD), Glutathione (GSH), and malondialdehyde levels (MDA)) and histopathologically (staining with Harris Hematoxylin and Eosin Y). Results: Melatonin receptor agonist treatment reduced the clinical score count of ocular inflammation in the uveitic rats. TNF-α, VEGF, caspase 9, and caspase 3 levels markedly decreased in the uveitic rats. Melatonin receptor agonists significantly ameliorated fixed changes in GSH, SOD, and MDA levels. Melatonin receptor agonists also ameliorated histopathological injury in eye tissues associated with uveitis. Conclusion: Melatonin receptor agonists ameliorated the inflammatory response in EIU. These findings suggest that melatonin receptor agonists may represent a potential novel therapeutic drug for uveitis treatment.

Evaluation of Systemic Endothelial Dysfunction in Retinal Vein Occlusions.

Objectives: Our aim in this study was to evaluate the systemic endothelial dysfunction status and carotid intima-media thickness (CIMT) in patients with retinal vein occlusion (RVO). Methods: Seventy-six patients who presented to the clinic with the diagnosis of RVO and 76 age- and gender-matched healthy individuals without a RVO history were included in the study. The patients' best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measures, and diabetes, hypertension, hyperlipidemia, carotid artery disease, body mass index, and smoking histories were recorded. The endothelial function levels of the patients, pulse wave velocity (PWV), flow-mediated dilation (FMD), and CIMT were measured. Endothelial dysfunction was detected by applying the FMD technique to the brachial artery. CIMT was evaluated by B-mode ultrasonography. Serum hematological parameters were evaluated. Results: BCVA (logMAR) was 1.39±1.30 in patients with RVO and 0.028±1.22 in the control group (p<0.001). CMT was 588.76±104.02 µm in patients with RVO and 265.20±45.11 µm in the control group (p=0.001). Hypertension, diabetes, and hyperlipidemia were found to be significantly higher in patients with RVO (p-value 0.001, 0.002, and 0.001, respectively). There was a significant difference between the groups in terms of FMD, PWV, and CIMT (all of them, p<0.001). Conclusion: The deterioration of FMD and PWV, which are indicators of endothelial dysfunction in patients with RVO, suggests that systemic endothelial dysfunction may play a role in the pathogenesis of RVO. Comprehensive studies with more patient participation are needed.

Factors Associated with Pain Level in Patients Receiving Intravitreal Injection.

PURPOSE: To identify the factors associated with the pain level in patients receiving intravitreal injection. METHODS: A total of 120 patients were prospectively evaluated, and 104 were included in the study. Patients were asked to rate their pain intensity from 0 to 10 on the visual analog scale. Factors that were possibly associated with pain level were evaluated using a sociodemographic data form, state anxiety inventory, and the hospital anxiety and depression scale. RESULTS: Of the participants, 54 (51.9%) were female, and 50 (48.1%) were male, with a mean age of 65 ± 9.01 years. There was a positive correlation between pain level and state anxiety scores (r = 0.30; P < 0.001) and a negative correlation between hospital anxiety score (r = -0.23; P = 0.02) and hospital depression score (r = -0.27; P = 0.01). The correlation between pain score and education level was significantly higher in primary and secondary school graduates (P < 0.01). Smokers were observed to have higher pain scores (6.50 ± 2.21 in smokers and 4.87 ± 2.50 in nonsmokers; P = 0.01). Among diagnostic groups, pain scores were found to be significantly lower in the diabetic retinopathy (DR) group (6.82 ± 1.99 in age-related macular degeneration, 5.94 ± 2.27 in retinal vein occlusion, and 3.58 ± 1.97 in DR; P < 0.001). When pain scores were evaluated according to the drug injected, the group receiving bevacizumab injection was observed to have higher pain scores (7.32 ± 1.81 in bevacizumab, 4.00 ± 2.08 in aflibercept, and 3.92 ± 1.96 in ranibizumab; P < 0.001). Based on the multiple regression analysis, the state anxiety score, hospital anxiety score, hospital depression score, and smoking status were observed not to be significant predictors. The level of education, diagnosis, and active substance were found to have a statistically significant effect on pain perception. CONCLUSION: In this study, pain levels have been found to be high in smokers, those with a low educational level, individuals receiving bevacizumab for intravitreal injection, and those having a higher level of state anxiety, whereas patients with DR have lower pain scores.

The Relationship of the Urotensin-2 Level in the Aqueous Humor with Systemic Diseases and Pupil Size: Comparative Study.

Purpose: To detect the presence of urotensin-2 (U-II) in the aqueous humor and evaluate the relationship between aqueous humor level and systemic diseases and pupil size. Methods: The study included 88 patients who underwent cataract surgery. Those with a pupil diameter (PD) of up to 4 mm were considered to have small dilation, those with 4-7 mm of dilatation were considered to have moderate dilation, and those with a PD of more than 7 mm considered to have large dilation. Patients with HT (hypertension) were classified as group 1, those with DM (diabetes mellitus) as group 2, and those with HT+DM as group 3, and those without any systemic disease as group 4. The U-II levels in humor aqueous samples taken from anterior chamber were measured. Results: When compared with the control group, it was observed that the level of U-II in the aqueous humor of the HT, DM, and DM+HT groups was significantly higher (P < 0.05). At the same time, when we compared the DM+HT group with the other groups, the level of U-II in the aqueous humor was significantly higher compared to the group with DM (P < 0.05). The U-II levels of the aqueous humor were higher in the patients with small pupils compared to the remaining groups (P < 0.005). Conclusion: U-II may play a role in small pupil pathophysiology. In addition, it was determined that patients with HT and/or diabetes had higher U-II levels in the aqueous humor than healthy individuals.

Correlation of the aqueous humor total antioxidant capacity, total oxidant status, and levels of IL-6 and VEGF with diabetic retinopathy status / Correlação entre níveis de humor aquoso da capacidade antioxidante total, estado oxidante total, IL-6, VEGF e status da retinopatia diabética

ABSTRACT Purpose: We aimed to compare the aqueous humor total oxidant status, total antioxidant capacity, and levels of interleukin-6 and vascular endothelial growth factor between patients with diabetic retinopathy and controls and to correlate these levels with the DR status. Methods: Patients who underwent cataract surgery were enrolled. The first group (control group) comprised patients without diabetes; the second group comprised diabetic patients without retinopathy; the third group comprised patients with nonproliferative diabetic retinopathy; and the fourth group comprised patients with proliferative diabetic retinopathy. All patients underwent full ophthalmologic examination before cataract surgery. Prior to surgery, samples of aqueous humor sampling were obtained and stored at -80 °C. Total antioxidant capacity, total oxidant status, and levels interleukin-6 and vascular endothelial growth factor were investigated in these samples and correlated with diabetic retinopathy status. Results: This study analyzed 86 pairs of eyes of 86 patients. All groups were statistically similar in age and sex, but the total antioxidant capacity was lowest in patients with proliferative diabetic retinopathy. Moreover, the total oxidant status and levels of vascular endothelial growth factor and interleukin-6 were found to slightly increase according to the retinopathy status. Conclusion: Oxidative stress, interleukin-6, and vascular endothelial growth factor in the aqueous humor seem to play important roles in the pathogenesis of diabetic retinopathy, especially in the proliferative type.

RESUMO Objetivo: Procurou-se comparar o humor aquoso estado oxidante total, a capacidade antioxidante total, e os níveis de interleucina-6 e do fator de crescimento endotelial vascular entre pacientes com retinopatia diabética e em indivíduos controles, e correlacionar esses níveis com o status da retinopatia diabética. Métodos: Pacientes submetidos à cirurgia de catarata foram incluídos. O primeiro grupo (grupo controle) foi composto por pacientes sem diabetes; o segundo grupo inclui pacientes dia béticos sem retinopatia; o terceiro grupo inclui pacientes com retinopatia diabética não proliferativa; e o quarto grupo inclui pacientes com retinopatia diabética proliferativa. Todos os pacientes foram submetidos a exame oftalmológico completo antes da cirurgia de catarata. Antes da cirurgia, amostras de humor aquoso foram obtidas e armazenadas a -80oC. A capacidade antioxidante total, o estado oxidante total e os níveis de interleucina-6 e fator de crescimento endotelial vascular foram investigados nessas amostras e correlacionados com o status da retinopatia diabética. Resultados: Este estudo analisou 86 pares de olhos de 86 pacientes. Todos os grupos foram estatisticamente semelhantes em idade e sexo, mas a capacidade antioxidante total foi menor em pacientes com retinopatia diabética proliferativa. Além disso, o estado oxidante total e os níveis de fator de crescimento endotelial vascular e interleucina-6 estavam ligeiramente aumentados de acordo com o status da retinopatia. Conclusão: O estresse oxidativo, a interleucina-6 e o fator de crescimento endotelial vascular no humor aquoso parecem desempenhar papel importante na patogênese da retinopatia diabética, especialmente no tipo proliferativo.

Correlation of the aqueous humor total antioxidant capacity, total oxidant status, and levels of IL-6 and VEGF with diabetic retinopathy status.

PURPOSE: We aimed to compare the aqueous humor total oxidant status, total antioxidant capacity, and levels of interleukin-6 and vascular endothelial growth factor between patients with diabetic retinopathy and controls and to correlate these levels with the DR status. METHODS: Patients who underwent cataract surgery were enrolled. The first group (control group) comprised patients without diabetes; the second group comprised diabetic patients without retinopathy; the third group comprised patients with nonproliferative diabetic retinopathy; and the fourth group comprised patients with proliferative diabetic retinopathy. All patients underwent full ophthalmologic examination before cataract surgery. Prior to surgery, samples of aqueous humor sampling were obtained and stored at -80 °C. Total antioxidant capacity, total oxidant status, and levels interleukin-6 and vascular endothelial growth factor were investigated in these samples and correlated with diabetic retinopathy status. RESULTS: This study analyzed 86 pairs of eyes of 86 patients. All groups were statistically similar in age and sex, but the total antioxidant capacity was lowest in patients with proliferative diabetic retinopathy. Moreover, the total oxidant status and levels of vascular endothelial growth factor and interleukin-6 were found to slightly increase according to the retinopathy status. CONCLUSION: Oxidative stress, interleukin-6, and vascular endothelial growth factor in the aqueous humor seem to play important roles in the pathogenesis of diabetic retinopathy, especially in the proliferative type.

Toxic anterior segment syndrome after uncomplicated cataract surgery possibly associated with intracamaral use of cefuroxime.

PURPOSE: To report toxic anterior segment syndrome (TASS) after cataract surgery possibly associated with intracameral use of cefuroxime. METHODS: We conducted a retrospective chart review and analysis on the pre- and postoperative conditions of the subjects who had developed TASS. RESULTS: The patient group consisted of 17 patients. Tyndallization and fibrin fibers were positive in all eyes. In four eyes, hypopyon formation developed. These reactions diminished on the third day and fully resolved 1 week after the operations with the use of intensive topical steroid and mydriatic therapy. To determine the etiology of TASS, infusion fluid, viscoelastics, and intracameral antibiotic agent were changed respectively. After changing intracameral antibiotic agent from cefuroxime axetile to moxifloxacin no new cases of TASS were diagnosed. CONCLUSION: All agents injected into the anterior chamber can cause TASS. Ophthalmologists and operating room staff need to pay careful attention to all drugs and irrigating solutions.