Six unexpected cases of presumed endophthalmitis after a single day of dropless cataract surgery

Introduction: 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. Patient and Clinical Findings: 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, Intervention, and Outcomes: 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. Conclusions: 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 with this technique.