Delayed-Onset Toxic Anterior Segment Syndrome Combined With Herpes Simplex Keratitis After Cataract Surgery

OBJECTIVE: To report a rare case of simultaneous delayed-onset toxic anterior segment syndrome (TASS) and herpes simplex keratitis (HSK) after cataract surgery, and to explore the diagnosis and treatment strategies. METHODS: A retrospective analysis was performed on the clinical data of a 78-year-old female patient. Seventeen days after right-eye cataract surgery, the patient presented with acute visual loss, red eye, photophobia and tearing. Ocular examination showed a sheet-like central corneal epithelial defect, fibrinous anterior chamber exudation, a membranous exudate on the intraocular lens surface, and clear vitreous. Emergency aqueous humor pathogen detection and intravitreal injection were performed to rule out infectious endophthalmitis. Subsequently, systemic and topical antiviral, anti-inflammatory and corneal nutritional treatments were given, followed by regular follow-up. RESULTS: Targeted multiplex pathogen detection of aqueous humor only detected opportunistic pathogens with extremely low read counts, which did not support the diagnosis of infectious endophthalmitis. After treatment, the patient's symptoms gradually relieved, corneal epithelium healed, anterior chamber exudates absorbed. At 23 days after discharge, the right-eye visual acuity recovered to 0.5. CONCLUSION: For delayed-onset anterior segment inflammation after cataract surgery, the possibility of coexisting multiple etiologies should be vigilant. Differential diagnosis from infectious endophthalmitis is the primary step. After excluding infection, careful combined antiviral and anti-inflammatory treatment can achieve a favorable prognosis.