Six unexpected cases of presumed endophthalmitis after a single day of dropless cataract surgery
Abstract
Dropless cataract surgery involves the intracameral injection of triamcinolone, moxifloxacin, and/or vancomycin for postoperative inflammation control, reducing the need for topical eyedrops. Endophthalmitis is a rare but serious complication, occurring in less than 1 in 5000 cases. This case series presents a unique occurrence in which 6 patients from a single surgical day developed presumed endophthalmitis or toxic anterior segment syndrome (TASS), highlighting a potential risk associated with batch-prepared intraocular injections.
Among 12 patients who underwent dropless cataract surgery on a single day in October 2019, 6 developed postoperative complications. These patients (2 males, 4 females) presented between postoperative days 2 and 4 with symptoms suggestive of intraocular inflammation. 3 patients were diagnosed with endophthalmitis, while the other 3 were diagnosed with TASS. 2 cases were further complicated by preexisting Fuch dystrophy.
Diagnosis was based on clinical presentation and examination findings. Endophthalmitis cases were treated with intravitreal vancomycin and ceftazidime, while TASS cases were managed conservatively. Preoperative visual acuity averaged 0.34 ± 0.14 logMAR (20/45 Snellen), improving to 0.075 ± 0.09 logMAR (20/25 Snellen) postoperatively.
Preparation of intraocular injections presents a potential risk for cohort complications. This case series underscores the need for further investigation into the safety and infection risk associated…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 12 participants or records.
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