Detection and analysis of antibiotic ointment in the anterior chamber following cataract surgery: A case report and literature review

Abstract

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.

Keywords

Cataract surgery antibiotic ointment anterior chamber corneal endothelial loss ultra-high performance liquid chromatography–tandem mass spectrometry

Introduction

Cataracts are the most common cause of blindness, and cataract surgery is the most effective and currently the only approved treatment method.¹ Phacoemulsification cataract surgery followed by intraocular lens (IOL) implantation can lead to rare complications, including the presence of ointment in the anterior chamber that has been reported in several cases in the literature.² Although there are no explicit guidelines mandating the immediate use of antibiotic ointment after cataract surgery, most surgeons follow this practice,³ which may allow antibiotic ointment to enter the anterior chamber. Only a few cases have been documented, and many physicians may not have encountered this complication, making it crucial to emphasize its prevention and management. Herein, we review the literature on similar instances and present a case, offering recommendations for prevention and management. This case report was prepared in accordance with the Case Report (CARE) guidelines (2013) to ensure completeness and transparency in reporting.⁴ Our previous preprint has reported preliminary findings on this topic.⁵

Cataract surgery

Cataract refers to the loss of lens transparency, resulting in opacification of the refractive medium.⁶ Phacoemulsification is the current gold standard for cataract treatment. During this procedure, an anterior opening is created in the lens capsule via capsulorhexis. The lens is then emulsified and aspirated through a 2.2–3.3 mm incision, followed by implantation of an IOL into the capsular bag.

The Cataract in the Adult Eye Preferred Practice Pattern published by the American Academy of Ophthalmology (AAO) states that inadequate wound sealing may result in postoperative complications, including wound leakage, hypotony, and endophthalmitis. An excessively large incision can lead to aqueous humor leakage and compromise anterior chamber stability during surgery, whereas an overly tight incision increases frictional resistance, resulting in heat generation by the phacoemulsification tip and an increased risk of corneal burn.⁷

Ointment in the anterior chamber following cataract surgery

As of 2025, a few case reports have documented the presence of ointment in the anterior chamber following cataract surgery, with varying degrees of ocular damage.

On slit-lamp examination, reflective, spherical, or bead-like particles may be observed floating in the anterior chamber angle, adhering to the iris, corneal endothelium, or IOL.^2,8,9 The mechanism underlying glaucoma may involve obstruction of the trabecular meshwork by fine ointment particles or inflammatory debris or secondary pupillary block, all of which impair aqueous outflow and result in elevated intraocular pressure (IOP). Symptoms include ocular pain and headache. Ointment remnants can affect both anterior and posterior segments, thereby delaying visual recovery.¹⁰ Involvement of the posterior segment may also induce retinal edema or macular degeneration.¹¹

Ointment primarily enters the anterior chamber through the surgical incision.¹² Reported formulations include tobramycin–dexamethasone, gentamicin–dexamethasone, chloramphenicol, and dexamethasone–neomycin–polymyxinB2 ointments.¹³ These complex formulations contain various components (e.g. preservatives and antibiotics); however, the specific agent(s) responsible for corneal endothelial toxicity remain unidentified, warranting further investigation.

Current clinical guidelines

Existing cataract guidelines lack explicit protocols for managing anterior chamber ointment.⁷ The majority of studies recommend immediate removal of the ophthalmic ointment once it is observed in the anterior chamber;^9,14 however, some studies suggest that anterior chamber ointment can be monitored via close follow-up observation.¹⁵ Timely removal is critical and may involve anterior chamber irrigation or pharmacologic dissolution. Regular follow-up with IOP monitoring and fundus examination facilitates early intervention. Posterior segment migration may require vitrectomy, with subsequent retinal evaluations to prevent edema or macular degeneration.¹¹ The impact of ointment residues demands heightened awareness, and future studies should elucidate the ocular toxicity of specific components.

Literature review

Literature search and selection process

A comprehensive systematic search was conducted across PubMed, Web of Science, VIP, China National Knowledge Infrastructure (CNKI), and Wanfang databases. The search strategy employed relevant keyword combinations using Boolean operators, particularly: “((cataract surgery) OR (postoperative)) AND ((antibiotic eye ointment) OR (eye ointment)) AND (anterior chamber).” No temporal restrictions were applied.

Initial screening of titles and abstracts was performed, followed by full-text review to identify studies reporting cases of anterior chamber eye ointment following cataract surgery. The inclusion criteria stipulated that the cases must involve postoperative anterior chamber eye ointment. Studies were excluded if they reported cases of ointment unrelated to cataract surgery or did not present new case reports. The selection process was conducted independently by two reviewers, with a third reviewer responsible for resolving disagreements.

As of 17 July 2025, a total of 91 articles were identified. Of these, 2 were review articles, 68 were irrelevant to the topic, 1 was a commentary, and 2 full texts could not be obtained. Ultimately, 18 studies met the inclusion criteria. Further snowballing from references within these studies identified 5 additional relevant articles, resulting in a total of 23 studies included in the final analysis.

Case selection and data extraction

From the 23 included studies, a total of 35 cases involving postoperative anterior chamber ointment were identified. Extracted data included author name, publication year, patient age, IOL type, time to ointment discovery, duration until the ointment was cleared, complications, timing of complications, and treatment measures. The summarized data are detailed in Table 1.^2,8–29

Table 1.

Summary of literature on intraocular ointment complications.

Author	Publication year	Age	IOL type	Time to ointment discovery	Duration till ointment clearance	Complications	Complications detected	Treatment
Scheie et al.²²	1965	49	NA	4 days	No	Mild corneal edema and neovascularization	<1 year	Follow-up for 18 years
Aralikatti et al.²	2003	77	AMO SA-40N	1 day	1 day	No	No	ACF and IOL exchange
Riedl et al.¹²	2003	72	NA	5 weeks	6 months	GlaucomaUveitis	4 months6 months	Drug induced hypotensionACF and AV
Chen et al.¹⁹	2005	70	LI 61 U	6 months	3 years	IOL surface contamination	6 months	IOL exchange
Humayun et al.¹⁰	2006	NA	LX10BD	1 day	No	No	No	Follow-up
		NA	LX10BD	1 day	No	No	No	Follow-up
		NA	LX10BD	1 day	No	No	No	Follow-up
		NA	LX10BD	1 day	No	No	No	Follow-up
Werner et al.¹⁸	2006	86	LI61U	12 days	4 months	Corneal edemaElevated IOP	1 week	PKP, IOL exchange,and second PKP
		75	LI61U	5 days	3 months	No	No	IOL exchange
		63	LI61U	7 days	3 weeks	Elevated IOPCorneal edema	1 week	ACFVitrectomyPKP and IOL exchange
		75	LI61U	1 day	1.5 months	No	No	YAG on the oily materialIOL exchange
		87	LI61U	1 day	2 months	No	No	Aspiration of bubble and polishing of IOL
		74	LI61U	2 months	8 months	Corneal edema	1 day	PKP and IOL exchange
		72	LI61U	5 days	7 days	Corneal edemaElevated IOP	1 days	AV and ACFTrabeculectomyGlaucoma valvePKP and IOL exchange
		73	LI61U	1 day	6 days	No	No	Aspiration of bubble and polishing of IOL
Wong and Bank²⁰	2006	77	SA60AT	2 months	2 months	No	No	IOL exchange
Chew et al.⁸	2006	55	SI-30NB	18 months25 months	19 months26 months	Inflammation in the anterior chamber	8 months	Diagnostic–therapeutic irrigation/aspiration and IOL exchange
Wong et al.²³	2009	77	NA	2 years	2 years	anterior uveitis	2 years	ACF
Murjaneh et al.²⁴	2010	NA	SI 40-NB	1 day	1 week	Completely occlude the visual axis	1 day	ACF
Murjaneh et al.²⁴	2010	NA	SI 40-NB	3 weeks	No	No	3 weeks	Follow-up for 6 months, and the material had completely disappeared spontaneously
Ugurbas and Akova²⁶	2010	65	SA60AT	1 month	26 months	Decreased vision, mild pain in the eye and cystoid macular edema	26 months	Removed
Shukla et al.¹⁶	2011	79	SA60AT	2.4 years	2.4 y	Chronic cystoid macular edema	1 week	ACF
Sheng-Li et al.²⁷	2011	62	Aqua-Sense	1 day	1 day	No	No	ACF
Sbordone et al²⁵	2014	NA	NA	4 weeks	NA	NA	NA	NA
Mansour et al.¹⁷	2015	84	NA	3 weeks	NA	Cystoid macular edemaDecreased CECD	3 weeks	Removed
Mansour et al.¹⁷	2015	82	NA	1 day	30 months	Corneal edemaEpithelial defects	18 months	Ointment removed with application of an amniotic membrane.
Guoping Leng²⁸	2015	68	NA	1 day	3 days	No	No	ACF
Katabami et al.²¹	2016	74	SN6AD1	10 months	10 months	No	No	ACF
Sanders et al.⁹	2018	74	NA	33 months	33 months	Macular edemaDecreased CECD	33 months, 39 months	ACF and sub-Tenon injection of triamcinolone
Kudo et al.¹¹	2018	63	Acrysof IQ®, Alcon	11 months	15 months	Macular edema,UveitisDecreased CECDVitreous opacity	14 months	ACF
Mohamed-Noriega et al.¹⁴	2022	71	Bausch & Lomb, ADAPT-AO	1 day	7 months	TASSDecreased CECD	1 day	ACF
Lin and Si¹⁵	2023	62	NA	3 day	6 days	No	No	ACF
Zhengwei Ge²⁹	2023	69	NA	1 day		TASSDecreased CECD	NA	Remove the eye ointment by draining the liquid from the corneal incision
Mwale-Md et al.¹³	2025	61	AMB00	1 week	1 weeks	No	No	ACF

IOL: intraocular lens; NA: not available; ACF: anterior chamber flushing; AV: anterior vitrectomy; IOP: intraocular pressure; PKP: penetrating keratoplasty; YAG: yttrium aluminum garnet laser capsulotomy; CECD: corneal endothelial cell density; TASS: toxic anterior segment syndrome.

Analyses of complications

The most frequently reported complications included corneal edema (6 cases, 17.1%), endothelial cell loss (5 cases, 14.2%), macular edema (5 cases, 14.2%), elevated IOP or glaucoma (4 cases, 11.4%), uveitis (3 cases, 8.5%), anterior segment inflammation or toxic anterior segment syndrome (TASS) (3 cases, 8.5%), corneal neovascularization (1 case, 2.8%), corneal epithelial defects (1 case, 2.8%), and vitreous opacity (1 case, 2.8%). Additional reported effects included reduced visual acuity and lens contamination, which were likely associated with the location and movement of the ointment.

Analyses of treatment interventions

Of the 35 cases, surgical removal of ointment was performed for 29 cases (82.9%), and IOL exchange was required in 13 cases (37.1%). Follow-up was performed for six cases, with complete disappearance of the ointment after 6 months in one case. No relevant changes were mentioned in the remaining follow-up cases in the literature.

Case report

Case description and patient details

A female patient approaching 70 years of age presented to Tianjin Eye Hospital on 7 September 2023 with a 1-year history of gradual decline in vision in her right eye. Examination results of the right eye revealed an uncorrected visual acuity of 0.3, clear cornea without edema, C3N3-stage cataract, and corneal endothelial cell density of 2370 cells/mm² (Figure 1(a)). The patient was diagnosed with immature cataract in the right eye.

Figure 1.

Ophthalmological examination of the patient. (a and b) Pre- and postoperative corneal endothelial cell density; (c) ocular appearance; (d) OCT imaging of the anterior chamber. OCT: optical coherence tomography.

On 25 September 2023, the patient underwent phacoemulsification cataract surgery under topical anesthesia, with implantation of a HOYA250 IOL (+22.5 D). Two 3.0-mm clear corneal incisions were made, one at the 10 o’clock position and one at the 2 o’clock position, and the incisions were confirmed to be watertight at closure. Postoperatively, the patient was prescribed levofloxacin eye drops and tobramycin–dexamethasone ointment, and the eye was covered with a protective patch.

On postoperative day 1, her visual acuity was measured at 0.09. Slit-lamp examination showed corneal edema; however, the IOL was well-centered, and no abnormalities were noted in the anterior chamber. The patient was advised to continue her medications, including diclofenac sodium and tobramycin and dexamethasone eye drops. At the 2-week follow-up, her visual acuity had improved to 0.6, with a clear cornea, well-centered lens, and no anomalies in the anterior chamber.

However, on 29 April 2024, the patient returned with complaints of “moving shadows” in her right eye for the past 5 months. A detailed history revealed that she had first noticed intermittent floaters 3 months postoperatively, which had persisted for 5 months without associated symptoms such as redness or pain. B-scan ultrasonography at this visit indicated vitreous opacities. Anterior segment photography illuminated an active lipid droplet–like foreign body in the anterior chamber (Figure 1(c)), leading to a diagnosis of anterior chamber foreign body in the right eye.

Surgical removal of ointment

On 3 July 2024, the patient underwent anterior chamber irrigation at our institution. Preoperative examination revealed visual acuity of 0.3 and IOP of 11 mmHg, with a clear cornea. Optical coherence tomography (OCT) identified an approximately spherical foreign body in the anterior chamber at the 12 o’clock position, with a mean diameter of 1.7 mm (Figure 1(d)). The density of corneal endothelial cells in the right eye was 673.8 cells/mm² (Figure 1(b)). The cell density was measured using the same machine and at the corresponding sites during both visits.

The surgical procedure was performed as follows:

The patient was placed in a supine position with routine disinfection and sterile draping of the surgical site.

A lid speculum was used to maintain eyelid openness, and 1% povidone–iodine solution was used to cleanse the conjunctival sac.

Topical anesthesia was administered using proparacaine.

Two 3.0-mm clear corneal incisions were made, one at the 10 o’clock position and one at the 2 o’clock position.

A viscoelastic agent was injected to the anterior chamber to push the foreign body toward the incision site, and forceps were used to pick up and collect the foreign body following its expulsion. No IOL exchange was performed due to the absence of lens contamination (see Supplementary Video)

The corneal incision was secured to ensure watertight closure.

Postoperative medication included levofloxacin and diclofenac sodium drops.

Postoperatively, the patient’s visual acuity remained at 0.3, with a clear cornea and well-positioned IOL. At the 1-week follow-up examination, no abnormalities were observed in the right eye, and visual acuity was maintained at 0.3.

Ultra-high performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS) analysis of postoperative lipid droplets

The foreign body retrieved during surgery was subsequently sent for analysis via UHPLC-MS/MS to the Tianjin Medical University School of Pharmacy.

The analysis was performed to identify and quantify the major components of the ointment residue. The surgical specimen was processed and analyzed according to standard protocols by our collaborators at the Tianjin Medical University School of Pharmacy.

Instrumental conditions included a Waters ACQUITY UPLC chromatographic system and a triple-quadrupole mass spectrometer equipped with an electrospray ionization (ESI) source.

Dexamethasone analysis

Chromatographic conditions

Separation was performed on an XBridge BEH C18 column (100 mm × 2.1 mm × 5 µm; Waters) maintained at 30°C. The mobile phase consisted of the following: (a) 0.1% formic acid in water and (b) acetonitrile, delivered at a flow rate of 0.3 mL/min. A gradient elution program was applied as follows: 0–7.0 min, 25% acetonitrile; 7.0–7.5 min, acetonitrile concentration was increased from 25% to 80%; 7.5–8.0 min, 80% acetonitrile; 8.0–10.0 min, acetonitrile concentration was decreased from 80% to 25%. The injection volume was 10 µL.

Mass spectrometric conditions

The ESI source was operated in the negative ion mode. Detection was performed in the multiple reaction monitoring (MRM) mode. The deprotonated molecule (M-H)⁻ at *m/z* 436.9 was monitored. Two characteristic product ion transitions were recorded: *m/z* 360.8 (quantifier ion, collision energy: 20 eV) and *m/z* 306.7 (qualifier ion, collision energy: 30 eV). The cone voltage was set at 30 V.

Tobramycin analysis

Chromatographic conditions

Given the high polarity of tobramycin, chromatographic separation was achieved using a method optimized for aminoglycosides. The mobile phase consisted of the following: (a) acetonitrile and (b) 0.5% formic acid in water, delivered at a flow rate of 0.45 mL/min. The column temperature was 40°C, and the injection volume was 5 µL. A suitable gradient elution program was applied.

Mass spectrometric conditions

The ESI source was operated in the positive ion mode with MRM detection. The protonated molecule (M + H)⁺ at *m/z* 468.3 was monitored. Two product ion transitions were used: *m/z* 163 (quantifier ion, collision energy: 30 eV) and *m/z* 324 (qualifier ion, collision energy: 20 eV). The cone voltage was set at 30 V.

Data analysis

Compound identification was based on matching the retention time and relative abundance of the MRM transitions with those of certified reference standards analyzed under identical conditions. Quantification was performed using external standard calibration curves established using the authentic tobramycin–dexamethasone ointment.

Results and conclusions

UHPLC-MS analysis of patient samples revealed the presence of characteristic peaks for dexamethasone, suggesting that the lipid droplets observed were residues of eye ointment in the anterior chamber. The results indicated the presence of dexamethasone, confirming tobramycin–dexamethasone ointment applied postoperatively as its source (Figure 2). Furthermore, the UHPLC-MS analysis for tobramycin exhibited lower ion peak responses, possibly attributable to a small-sample volume or the rapid metabolic clearance of tobramycin (Figure 2).

Figure 2.

UHPLC-MS analysis of dexamethasone and tobramycin. (a) UHPLC-MS analysis of dexamethasone. From top to bottom: blank (methanol), standard ointment, and sample. The ion peak of the lipid droplet–like foreign body corresponds to the ion peak of the standard ophthalmic ointment, which confirms that the lipid droplet–like foreign body contains dexamethasone. (b) UHPLC-MS analysis of tobramycin. From top to bottom: blank (methanol), standard ointment, and sample. The ion peak of the measured sample shows a low response compared with that of tobramycin. UHPLC-MS: ultra-high performance liquid chromatography–tandem mass spectrometry.

Discussion

Causes of ointment entry into the anterior chamber

Lipid droplets were observed in the patient’s anterior chamber 8 months postoperatively. This delayed presentation may be attributed to the initially minute size of the entering ointment particles, which gradually coalesced into a detectable aggregate. Furthermore, the droplets might have been sequestered behind the iris due to the patient’s posture, rendering them temporarily invisible on anterior segment examination. Although the majority of clear corneal incisions in cataract surgeries are designed to be watertight, ocular ointments may unintentionally be drawn into the anterior chamber because of the negative pressure created by the removal of the speculum and squeezing of the eyeball and eyelid. When patients apply pressure to their eyelids or blink forcefully, negative pressure is generated, potentially allowing tiny lipid droplets to enter the anterior chamber through the corneal incision. For standard watertight clear corneal incisions, normal or elevated IOP can help prevent wound leakage. In cases of low IOP, the wound can begin to open from within toward the periphery.³⁰ Sarayba et al.³¹ employed human cadaver eyes and Indian ink to demonstrate the flow of ink into the anterior chamber through corneal incisions when the IOP was reduced to 5 mmHg. Additionally, they observed that in 3 eyes with baseline IOP ranging from 15 to 18 mmHg, manual pressure applied to the corneal surface resulted in the ink entering the anterior chamber, particularly in the brief moment following the release of that pressure. Consequently, transient postoperative hypotony may be a driving force behind the entry of ocular ointments into the corneal incision.

Causes of decreased corneal endothelial density

According to the records of the Food and Drug Administration (FDA) regarding tobramycin–dexamethasone ointment, each gram contains the following active ingredients: (a) tobramycin (0.3%, 3 mg); (b) dexamethasone (0.1%, 1 mg); and (c) preservatives such as chlorobutanol (0.5%) and inactive ingredients, including mineral oil and white petrolatum.³² There are two forms of natural petrolatum, white and yellow, with white petrolatum being the more refined version that is processed to remove impurities, including polycyclic aromatic hydrocarbons (PAHs).³³ In a study conducted by Scheie et al.,²² mineral oil injected into rabbit eyes was observed as small, freely moving spheres. After 2 weeks, corneal endothelial cell loss was noted in regions exposed to the mineral oil. Similarly, the injection of petrolatum into rabbit eyes resulted in complete endothelial cell loss in the areas of contact within 4 weeks. Yao et al.³⁴ have confirmed, through their work involving animal studies, that the combination of dexamethasone and glucose can effectively treat postoperative corneal edema without reducing endothelial cell counts. Retrospective studies have suggested that intravitreal injections of the combination of dexamethasone and moxifloxacin (Vigadexa®) demonstrate no toxicity to corneal endothelial cells after anterior chamber injection following phacoemulsification.³⁵ In addition to chemical toxicity, physical compression by an ointment bolus in the anterior chamber can induce mechanical stress on the endothelial cells. Ramirez-Garcia et al.³⁶ have shown that corneal endothelial cells are highly susceptible to mechanical indentation and local pressure. Therefore, we conclude that the observed endothelial damage is primarily attributable to the ointment vehicle (white petrolatum and mineral oil) and secondarily to mechanical compression.

Ointment use following intraocular surgery

The routine prophylactic use of antibiotic–steroid ointments at the conclusion of intraocular surgery warrants reconsideration. A large-scale study by Zhang et al.³⁷ involving 3811 patients has reported that postoperative tobramycin–dexamethasone ointment did not significantly reduce the risk of endophthalmitis; however, it was associated with an increased incidence of specific adverse effects. Given the potential for severe complications as documented in our review and case report, we strongly recommend avoiding the immediate application of antibiotic ointment onto the ocular surface following cataract surgery. As reviewed by Matossian et al.,³⁸ wound stability may persist for up to 1 week postoperatively, and the effectiveness of stromal hydration lasts from 1 day to 1 week. The same review emphasizes that the risks of suture-related complications and wound leakage are most pronounced during the early postoperative period.³⁸ Additionally, relevant guidelines recommend that the first postoperative assessment be performed on day 1.⁶ Therefore, initiating antibiotic ointment after 24 h, followed by gradual transition tailored to the patient’s IOP, wound leakage status, and local healing response during the initial follow-up, enables effective infection prophylaxis and minimizes the risk of associated complications.

Strengths and limitations associated with this case report

This study highlights a rare but vision-threatening complication: the entry of antibiotic ointment in the anterior chamber following cataract surgery. Its strengths include the systematic review of 35 reported cases and presentation of a novel case with definitive compositional analysis. The confirmation of dexamethasone within the anterior chamber lipid droplet via UHPLC-MS/MS is a key finding, which provided concrete evidence of the ointment’s source. This study also details the causes of corneal endothelial cell loss, primarily the ointment’s vehicle components and mechanical compression. Furthermore, the study provides actionable clinical guidance, which includes avoiding immediate postoperative ointment use, ensuring prompt removal of intraocular ointment, omitting preoperative pupil dilation during extraction, and avoiding improper procedures. It would be valuable to include guidelines that discourage inappropriate practices, such as the misuse of ointments or iodine in the surgical field. These recommendations offer practical insights for optimizing perioperative care.

Despite these merits, several limitations remain. First, the retrospective, small-sample design may have introduced selection bias and limited the generalizability of the findings. Second, the absence of a control group prevented accurate quantification of complication risks arising from ointment exposure. Third, etiological analyses were restricted to the tobramycin–dexamethasone ointment, leaving the effects of other formulations’ unexamined. Finally, insufficient long-term follow-up data disallowed evaluation of the lasting impacts of the loss of endothelial cells on visual function.

Conclusion

Recommendations for prevention and management

Based on our findings and literature review, we proposed the following recommendations for prevention and management.

Avoid immediate postoperative ointment. Topical eye drops should be preferred over ointment during the immediate postoperative period. It is recommended that patients undergo their initial postoperative review on postoperative day 1, after which the use of antibiotic eye ointment should be gradually introduced based on their IOP, wound leakage, and local healing process.

Optimize surgical closure and postoperative care. Meticulous watertight wound closure is paramount. Surgeons should remove the speculum gently, avoid pressure bandages, and explicitly instruct patients against eye rubbing.

Conduct a thorough postoperative assessment. The first postoperative examination should include a careful inspection of the anterior chamber, including behind the iris, to detect occult ointment deposits.

Adapt surgical removal technique. During removal surgery, preoperative mydriasis should be avoided if the IOL is clear, as this minimizes the risk of IOL contamination. However, if the IOL is already contaminated or its optical clarity is compromised, exchange with a new lens should be considered. Surgical techniques may include a double incision technique, similar to that used in cataract extraction, with viscoelastic agents injected on one side and a blunt suction cannula employed to remove the contents from the other side. It can also be extracted by gently pressing the back edge of the main incision.

Timely removal of anterior chamber ointment. Once ointment is detected in the anterior chamber, prompt surgical removal is indicated. This intervention is critical to halt ongoing endothelial toxicity, preserve corneal health, and prevent secondary complications such as persistent inflammation, elevated IOP, and cystoid macular edema.

Taken together, the presence of ointment in the anterior chamber following cataract surgery poses significant risks to corneal health. Prevention strategies, thorough postoperative evaluations, and timely interventions are essential to mitigate complications associated with foreign bodies in the anterior chamber.

Supplemental Material

sj-mp4-1-imr-10.1177_03000605261443166 - Supplemental material for Detection and analysis of antibiotic ointment in the anterior chamber following cataract surgery: A case report and literature review

Supplemental material, sj-mp4-1-imr-10.1177_03000605261443166 for Detection and analysis of antibiotic ointment in the anterior chamber following cataract surgery: A case report and literature review by Hanlu Liu, Xiafei Chen, Zhongxu Ma, Junmei Lu and Xuan Li in Journal of International Medical Research

Footnotes

Acknowledgments

We thank Professor Linyi Dong from the School of Pharmacy at Tianjin Medical University for their assistance in analyzing the components of the lipid droplet.

Authors’ contributions

Conception and design: H.L., Z.M., and X.L. Methodology: H.L., Z.M., and X.L. Acquisition of data: H.L. Analysis and interpretation of data: H.L. and X.C. Writing: H.L. and X.C. Review or revision of the manuscript: H.L., X.C., Z.M., J.L., and X.L. Study supervision: X.L. All authors reviewed the manuscript.

Clinical trial registration

This study did not involve a clinical trial and therefore was not registered.

The authors confirm that the PI for this paper is Hanlu Liu and that she held direct clinical responsibility for patients.

Consent to publish statement

Informed consent was obtained in writing from the patient for publication of the details regarding their case and any accompanying images.

Data availability statement

All data generated or analyzed during this study are included in this article and its online supplementary material files. Further inquiries can be directed to the corresponding author.

Declaration of conflicting interests

The authors have no conflicts of interest to declare.

Ethics approval statement

This research involved human participants. However, it was performed with minimal risk to participants. In accordance with our institution’s policies for exempt research, formal ethical approval was not sought. All participants were provided an information sheet and informed consent was obtained prior to participation.

Funding

This study was supported by The Science & Technology Development Fund of Tianjin Education Commission for Higher Education (Grant No. 2025ZXZD023).

Patient consent statement

The patient consent statement is attached in a separate document.

Permission to reproduce material from other sources

No permission to reproduce material from other sources was required for this manuscript.

ORCID iDs

Xiafei Chen

Xuan Li

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