Phacoemulsification cataract surgery can be complicated by the inadvertent introduction of antibiotic ointment into the anterior chamber, resulting in rare but severe complications such as endothelial cell loss. We reviewed 35 cases from 23 studies and also presented a case report of an older female with a lipid droplet–like foreign body in the anterior chamber postoperatively. The foreign body was surgically removed and confirmed to contain dexamethasone via ultra-high performance liquid chromatography–tandem mass spectrometry. Clinical data indicated that 82.9% of cases required ointment removal, and 37.1% needed intraocular lens exchange. In the present case, the patient’s corneal endothelial cell density decreased, whereas visual acuity remained stable following cataract surgery. The primary causes of endothelial cell loss included contact with white petrolatum, mineral oil present in tobramycin–dexamethasone ointment, and mechanical compression within the anterior chamber. We conclude that antibiotic eye ointment should not be used immediately after cataract surgery, and prompt removal is recommended if ointment is detected in the anterior chamber. To reduce intraocular lens contamination, ointment removal surgery should be performed without preoperative pupil dilation. Vigilance and timely intervention are essential, given the potential severity of these rare complications.
Liu et al. (Fri,) studied this question.