Postoperative endophthalmitis rate associated with routine off-label reuse of single-use phacoemulsification cassettes in more than 1,000,000 consecutive surgeries

According to a 2025 APAO survey, reuse of phacoemulsification tubing and cassettes appears to be more common in Asian-Pacific countries compared to Europe and North America. We analyzed the phacoemulsification postoperative endophthalmitis (POE) rate from 2016 to 2024 at the Aravind Eye Care System's 15 hospital network. Single-use phacoemulsification cassettes were routinely reused all day (off label) at every facility during this 9-year period. The POE rate was 0.01 % in 1,133,959 consecutive cases. This rate was consistent from year to year and compared favorably with contemporaneous POE data from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry (0.06 %), where presumably no reuse of phacoemulsification cassettes would have been allowed. We found no evidence that reusing the same phacoemulsification tubing and cassette all day increased the rate of POE.