Complications And Management Of Retained Ointment In The Anterior Chamber After Cataract Surgery
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT022 | Type: Case Report | DOI: 10.82333/ve0y-4390
Authors: Mrs Elena Brotons Muñoz* 1 , Mireia Minguell Barbero 2 , Dr Anna Casablanca Piñera 1 , Dr Alfonso Beltran Arasa 1 , Dr Bernardo Sánchez Dalmau 1 , Dr Pablo Martí Rodrigo 1 , Dr Eixarch Dualde Anna 2
1Ophthalmology,Hospital Clinic de Barcelona,Barcelona,Spain, 2Ophthalmology,Hospital Universitari Mútua Terrassa,Terrassa,Spain
Purpose
To describe a series of four cases of retained ophthalmic dexamethasone–chloramphenicol ointment in the anterior chamber following clear corneal phacoemulsification without sutures and posterior chamber intraocular lens implantation, performed in two tertiary referral Spanish hospitals between 2023 and 2026. To analyze the clinical spectrum, which included post-phacoemulsification uveitis, ocular hypertension, and one asymptomatic case, as well as the different management strategies and their outcomes.
Setting
Retrospective descriptive case series conducted at two tertiary referral Spanish hospitals.
Report of case
A total of four cases were included (two women and two men; mean age 71.8 years) who underwent clear corneal phacoemulsification with posterior chamber monofocal IOL implantation in two tertiary Spanish hospitals. Anesthesia was sub-Tenon in three cases and retrobulbar in one due to pseudoexfoliation with poor mydriasis requiring iris hooks.
Two 71-year-old patients developed ocular hypertension within 24 hours (48 and 34 mmHg, respectively), with minimal anterior chamber reaction and retained ointment observed in the anterior chamber. Delayed removal under topical anesthesia one week later was uneventful, with complete visual recovery.
A 69-year-old woman presented one month postoperatively with conjunctival hyperemia, mild discomfort, and minimal Tyndall, without IOP elevation (13 mmHg), although she was receiving topical carteolol for pre-existing glaucoma. Elective surgical removal was performed without complications.
A 76-year-old man required early reintervention for retained nuclear fragments following phacoemulsification performed the previous day. A small ointment remnant was detected at 24 hours at the main corneal incision. Given its small size, absence of inflammation, normal IOP (14 mmHg), and the patient’s preference to avoid further surgery, conservative management was adopted. At six months, best-corrected visual acuity was 1.0, with no inflammatory signs or detectable remnants on slit-lamp examination or gonioscopy.
Conclusion/Take home message
Published clinical reports indicate that intraocular ointment may be well tolerated in some patients without immediate adverse effects. However, persistent retained ointment in the anterior chamber carries significant risks, including secondary glaucoma, uveitis, and chronic inflammation.
The decision to perform surgical removal should be individualized, taking into account persistence of the material, symptomatology, and associated complications. First postoperative day examination is essential for early detection, and regular follow-up visits allow careful monitoring of intraocular pressure, inflammation, and visual function. In the presence of toxicity signs, prompt removal is recommended.