Incidence of toxic anterior segment syndrome and endophthalmitis in 190 000 eyes in a high-volume, multisurgeon, national network of ambulatory surgical centers using uniform perioperative protocols

Plain Language Summary Toxic anterior segment syndrome (TASS) and postoperative endophthalmitis are rare but serious complications of intraocular surgery. Real-world incidence data from high-volume ambulatory surgical centers (ASCs) remain limited. We retrospectively analyzed 190,005 consecutive eyes undergoing cataract surgery or refractive lens exchange between January 2022 and April 2025 across 54 ASC sites. All cases were performed by 172 surgeons using standardized perioperative and sterilization protocols. Suspected TASS and endophthalmitis events were independently validated and centrally reviewed. Ten TASS cases were identified (0.0053%; 95% CI, 0.0029–0.0097%), including one bilateral case, all resolving with topical corticosteroids. Three endophthalmitis cases occurred (0.0016%; 95% CI, 0.0005–0.0046%), each managed successfully with intravitreal antibiotics and vitrectomy as indicated. No clustering was observed. The incidence of TASS and endophthalmitis in this national ASC network was markedly lower than reported in hospital-based studies. These findings support the safety of standardized high-volume ASC environments, including immediate sequential bilateral surgery. Plain Language SummaryThis study looked at the occurrence of two rare complications, TASS and endophthalmitis, after eye surgeries in high-volume ambulatory surgical centers (ASCs). Researchers analyzed data from 190,005 surgeries performed by 172 surgeons across 54 ASCs. They found 10 cases of TASS (0.0053%) and 3 cases of endophthalmitis (0.0016%), all successfully treated. The rates were lower than those reported in hospital settings, suggesting that standardized procedures in ASCs are safe and effective. This supports the use of ASCs for high-volume surgeries, including immediate sequential bilateral operations, due to their low complication rates. Text is machine generated and may contain inaccuracies. FAQ