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The TAS-20 is scored by summing the item scores. The total score can range from 20 to 100, with higher scores indicating a greater degree of alexithymia. Alexithymia is thought to be a risk factor for a number of mental and physical health problems, including depression, anxiety, cardiovascular disease, and chronic pain. Our current system consists of a 7 million gallon per day Water Treatment Plant and a 2 million gallon per day Wastewater Treatment Plant. We have 259 miles of water lines and 52 miles of wastewater lines. Our system has the capability to service our customers through our 9 water pumping stations and 18 sewer lift stations.
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At post-operative week six, visual acuity had improved to 20/30 in the affected eye. Although most surgeons have abandoned intracameral use of agents containing preservatives, inadvertent administration of these preservatives may result in TASS. Benzalkonium chloride is a frequently cited offender, and care should be taken to ensure medications instilled intracamerally do not contain this preservative (69-71). This agent not only causes dose-related inflammation to extraocular structures like the conjunctiva, it is also reported to make structural alterations to the endothelium even at exceedingly low concentrations (110). It is generally recommended to avoid the intraocular use of medications and solutions that contain benzalkonium chloride, thimerosal, eidetic acid, and sodium bisulfite (111). Similar to endophthalmitis, TASS cannot be prevented completely but the rate may be reduced.
TASS is an activation of inflammatory cascades in the anterior chamber in response to external material or inappropriate solutions during cataract surgery. The response is typically apparent and symptomatic hours after surgery. Severe inflammatory reactions in response to the contamination, toxins, imbalanced solutions, medications or preservatives in the medications. This is a sterile anterior segment reaction.
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(A) Diffuse Descemet’s folds and limbus to limbus corneal edema; (B) an anterior chamber 4+ inflammatory cell reaction without hypopyon. Investigators at one center found an ointment containing gentamicin and betamethasone as a likely cause of eight TASS related cases, performed by the same surgeon. Mass spectrometry identified a mixed chain hydrocarbon compound on both the intraocular lens extract and within the ointment used post-operatively. The authors suggested that wound integrity and tight eye patching that was used may have contributed to the ointment gaining access into the anterior chamber. Although endophthalmitis cannot be prevented completely, many preoperative, intraoperative, and postoperative strategies are helpful in prophylaxis. Common practices include antisepsis with povidone-iodine and prophylactic topical antibiotics.
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