Incidence of TASS and endophthalmitis in high-volume, multi-center, multi-surgeon settings employing uniform perioperative protocols
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Introduction: 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. Methods: We retrospectively analyzed 190,005 consecutive eyes (109,121 patients) 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. Results: 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. Conclusion: 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.