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small-incision cataract surgery causing chron- ic uveitis and secondary glaucoma. J Cataract Refract Surg 2003;29:1022–25. 4. Fraunfelder FR, Hanna C. Ophthalmic oint- ment. Trans Am Acad Ophthalmol Otolaryngol 1973;77:467–75. 5. Ohrstrom A, Svensson B, Tegenfeldt S, Celiker C, Lignell B. Silicone oil content in ophthalmic viscosurgical devices. J Cataract Refract Surg 2004;30:1278–80. 6. McDonnell PJ, Taban M, Sarayba M, Rao B, Zhang J, Schiffman R, Chen Z. Dynamic morphology of clear corneal cataract incisions. Ophthalmology 2003;110:2342–2348. 7. Herretes S, Stark WJ, Pirouzmanesh A, Reyes JM, McDonnell PJ, Behrens A. Inflow of ocular surface fluid into the anterior chamber after phacoemulsification through sutureless corneal cataract wounds. Am J Ophthalmol 2005;140:737–40. Editors' note: Drs. MacLean, Mamalis, and Werner are affiliated with the John A. Moran Eye Center, University of Utah, Salt Lake City. They have no financial interests related to this article. Contact information MacLean: kyle.maclean@hsc.utah.edu Mamalis: nick.mamalis@hsc.utah.edu Werner: liliana.werner@hsc.utah.edu 2. Instruments used and their prepa- ration, including silicone sleeves covering phaco tips during the autoclaving process, were hypoth- esized as a possible source of oily substance contamination. During analysis by GC-MS, however, their profile did not match that of the substance found on the explanted lenses. 3. Other medications used before and after the procedure, such as lidocaine gel and pilocarpine gel, were analyzed by GC-MS and did not match the substance found on the explanted lenses. EW References 1. Werner L, Sher JH, Taylor JR, Mamalis N, Nash WA, Csordas JE, Green G, Maziarz EP, Liu XM. Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery. J Cataract Refract Surg 2006;32:227–35. 2. Garzozi HJ, Muallem MS, Harris A. Recur- rent anterior uveitis and glaucoma associated with inadvertent entry of ointment into the anterior chamber after radial keratotomy. J Cataract Refract Surg 1999;25:1685–87. 3. Riedl M, Maca S, Amon M, Nennadal T, Kruger A, Barisani T. Intraocular ointment after The surgeon of the 2 cases pre- sented in this article discontinued the use of postoperative eye patch- ing and began to use eye drops in place of ointment in the immediate postoperative period. No further cas- es of TASS from oily substances were reported after these changes were made. Given the risk of TASS from inflow of ointment to the anterior chamber, eye drops may provide a safer alternative for postopera- tive treatment. Avoidance of eye patching may also help to reduce the amount of ocular surface fluid that is able to penetrate the anterior chamber. Differential diagnosis 1. Silicone oil used in vitreoretinal surgery can adhere to silicone lenses and cause optical aber- rations. For this reason silicone lenses are not recommended as implants in patients who have had previous or may have vitre- oretinal problems requiring the use of silicone oil. The patients in our cases, however, did not have a known history of vitreoretinal disease or interventions. Figure 3. Light photomicrographs from the explanted silicone lens in case 1. The oily material was found to coat large areas of the anterior and posterior surfaces of the lens optic, with intervening clear areas. Source: Nick Mamalis, MD, and Liliana Werner, MD Figure 1. Slit lamp photograph from case 1. Corneal edema can be seen where the oily material was found to be coating the corneal endothelium. Figure 2. Slit lamp photograph from case 2. The oily material can be seen as a large bubble floating into the anterior chamber. Advancing CATARACT SURGERY © 2015 Novartis 3/15 ORA15009JAD-C ORA ™ SYSTEM IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USE: The ORA ™ System uses wavefront aberrometry data in the measurement and analysis of the refractive power of the eye (i.e. sphere, cylinder, and axis measurements) to support cataract surgical procedures. CONTRAINDICATIONS: The ORA ™ System is contraindicated for patients: who have progressive retinal pathology such as diabetic retinopathy, macular degeneration, or any other pathology that the physician deems would interfere with patient fi xation; who have corneal pathology such as Fuchs', EBMD, keratoconus, advanced pterygium impairing the cornea, or any other pathology that the physician deems would interfere with the measurement process; whose preoperative regimen includes residual viscous substances left on the corneal surface such as lidocaine gel or viscoelastics; with visually signifi cant media opacity (such as prominent fl oaters or asteroid hyalosis) what will either limit or prohibit the measurement process; or who have received retro or peribulbar block or any other treatment that impairs their ability to visualize the fi xation light. In addition, utilization of iris hooks during an ORA ™ System image capture is contraindicated, because the use of iris hooks will yield inaccurate measurements. WARNINGS AND PRECAUTIONS: Signifi cant central corneal irregularities resulting in higher order aberrations might yield inaccurate refractive measurements. Post refractive keratectomy eyes might yield inaccurate refractive measurement. The safety and eff ectiveness of using the data from the ORA ™ System have not been established for determining treatments involving higher order aberrations of the eye such as coma and spherical aberrations. The ORA ™ System is intended for use by qualifi ed health personnel only. Improper use of this device may result in exposure to dangerous voltage or hazardous laser-like radiation exposure. Do not operate the ORA ™ System in the presence of fl ammable anesthetics or volatile solvents such as alcohol or benzene, or in locations that present an explosion hazard. ATTENTION: Refer to the ORA ™ System Operator's Manual for a complete description of proper use and maintenance of the ORA ™ System, as well as a complete list of contraindications, warnings and precautions. July 2015 Two cases of TASS continued from page 28

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