Incidence of TASS and endophthalmitis in 190,000 eyes in a high-volume, multi-surgeon, national network of ambulatory surgical centers using uniform perioperative protocols

Avi Wallerstein; Vikram Lekhi; Ike K Ahmed; Mona Harissi-Dagher; Darren Albert; John Lloyd; Louis Racine; Pierre Trottier; Mark Cohen; Mathieu Gauvin

doi:10.1097/j.jcrs.0000000000001844

Incidence of TASS and endophthalmitis in 190,000 eyes in a high-volume, multi-surgeon, national network of ambulatory surgical centers using uniform perioperative protocols

J Cataract Refract Surg. 2025 Nov 25. doi: 10.1097/j.jcrs.0000000000001844. Online ahead of print.

Authors

Avi Wallerstein^{1

2}, Vikram Lekhi^{2

3}, Ike K Ahmed^{4

5}, Mona Harissi-Dagher^{1

2

6}, Darren Albert^{1

2}, John Lloyd^{2

4}, Louis Racine^{2

6}, Pierre Trottier², Mark Cohen^{2

7}, Mathieu Gauvin^{1

2}

Affiliations

¹ Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, QC, Canada.
² LASIK MD, Montreal, QC, Canada.
³ Department of Surgery, Faculty of Medicine and Health Sciences, University of Calgary, Calgary, AB, Canada.
⁴ John Moran Eye Center, University of Utah, Salt Lake City.
⁵ Prism Eye Institute, Toronto, Ontario.
⁶ Department of Ophthalmology, University of Montreal, Montreal, QC, Canada.
⁷ Department of Surgery, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.

PMID: 41287204
DOI: 10.1097/j.jcrs.0000000000001844

Abstract

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.

Keywords: ambulatory surgical centers; cataract surgery; endophthalmitis; immediate sequential bilateral cataract surgery; intracameral antibiotics; refractive lens exchange; sterilization protocols; toxic anterior segment syndrome.