Detection of Antibiotic Ointment in the Anterior Chamber and Analysis of Related Issues Following Phacoemulsification Cataract Surgery

Detection of Antibiotic Ointment in the Anterior Chamber and Analysis of Related Issues Following Phacoemulsification Cataract Surgery | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 19 May 2025 V1 Latest version Share on Detection of Antibiotic Ointment in the Anterior Chamber and Analysis of Related Issues Following Phacoemulsification Cataract Surgery Authors : Xuan Li 0000-0003-1052-4222 [email protected] , Hanlu Liu 0009-0004-8405-7414 , Xiafei Chen 0009-0004-7147-7559 , Zhongxu Ma , and junmei Lu Authors Info & Affiliations https://doi.org/10.22541/au.174763655.52913645/v1 224 views 150 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Purpose: We report a case of a 69-year-old female patient who developed a lipid droplet-like foreign body in the anterior chamber 8 months after undergoing phacoemulsification cataract surgery with intraocular lens implantation. Location: Cataract Center, Tianjin Eye Hospital, Tianjin, China. Methods: The lipid droplet was surgically removed from the anterior chamber and sent to Tianjin Medical University School of Pharmacy for analysis, confirming the presence of dexamethasone in the foreign body. Results: The patient experienced a significant decrease in corneal endothelial cell density compared to preoperative levels and her vision remained stable after the removal of the ointment. Conclusion: The presence of tobramycin-dexamethasone ointment in the anterior chamber post-surgery was identified as the primary cause of corneal endothelial cell density loss, attributed mainly to white petroleum and mineral oil. Surgical intervention to remove the ointment from the anterior chamber should be performed promptly. During surgery, mydriasis should be avoided to prevent contamination of the intraocular lens. Title: Detection of Antibiotic Ointment in the Anterior Chamber and Analysis of Related Issues Following Phacoemulsification Cataract Surgery Running Title： Antibiotic Ointment in the Anterior Chamber after Cataract Surgery Corresponding author： Xuan Li The first author ： Hanlu Liu，Xiafei Chen，Zhongxu Ma The second author ： Junmei Lu Institutional affiliation Xuan Li, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University Hanlu Liu, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China Xiafei Chen ，Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China Zhongxu Ma, Tianjin Eye Hospital, Tianjin, China Junmei Lu, School of Medicine. Nankai University, Tianjin., China Corresponding author contact information: No.4 Gansu Road, Heping District, Tianjin, 300020, China, [email protected] The authors confirm that the Principal Investigator for this paper is Hanlu Liu and that she had direct clinical responsibility for patients. Key Word: Ophthalmology; Mass Spectrometry; Antibiotics Word count :1441. Table count :1. Figure count :2. What is already known about this subject Phacoemulsification cataract surgery followed by intraocular lens implantation can lead to rare complications, including the presence of ointment in the anterior chamber. Anterior chamber antibiotic ointment may cause corneal edema. What this study adds’ statements 1. The presence of tobramycin-dexamethasone ointment in the anterior chamber post-surgery was identified as the primary cause of corneal endothelial cell density loss, attributed mainly to white petroleum and mineral oil. 2. Surgical intervention to remove the ointment from the anterior chamber should be performed promptly. 3. During surgery, mydriasis should be avoided to prevent contamination of the intraocular lens. Abstract: This case report describes a 69-year-old woman who developed a lipid droplet-like foreign body in her anterior chamber eight months after undergoing phacoemulsification cataract surgery with intraocular lens implantation. The foreign body was surgically removed and analyzed, confirming the presence of dexamethasone in the foreign body. The patient showed a significant decrease in corneal endothelial cell density compared to preoperative levels, although her vision remained stable following the removal of the ointment. The presence of tobramycin-dexamethasone ointment in the anterior chamber post-surgery was identified as the primary cause of corneal endothelial cell density loss, attributed mainly to white petroleum and mineral oil. Postoperative accumulation of ointment in the anterior chamber following cataract surgery is associated with various complications, and measures should be taken to prevent their occurrence and to remove it promptly. 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 implantation can lead to rare complications, including the presence of ointment in the anterior chamber, which has been reported multiple times in the literature [2] . However, there are few documented cases, and many physicians may not have encountered this situation, making it crucial to emphasize the prevention and management of such occurrences. Methods and Results: A 69-year-old female patient presented to Tianjin Eye Hospital on September 7, 2023, due to a gradual decline in vision in her right eye over the past year. Examination results of the right eye included uncorrected visual acuity of 0.3, clear cornea without edema, C3N3-stage cataract, and a corneal endothelial cell density of 2370/mm²(Fig.1A). The patient was diagnosed with immature cataract in the right eye. On September 25, 2023, the patient underwent phacoemulsification cataract surgery under topical anesthesia, with the implantation of a HOYA250 intraocular lens (+22.5D). A 3.0 mm clear corneal incision was made at the 10 o’clock and 2 o’clock positions, ensuring watertight closure of the incision. Postoperatively, the patient was prescribed levofloxacin eye drops and tobramycin-dexamethasone ointment, with the eye covered by a protective patch. On the first day after surgery, her visual acuity was measured at 0.09, with corneal edema but a well-centered intraocular lens and no abnormalities noted in the anterior chamber. The patient was advised to continue with medications, including Diclofenac sodium and Tobramycin and Dexamethasone eye drops. By the two-week follow-up, the patient’s visual acuity had improved to 0.6, with a clear cornea, well-centered lens, and no anomalies in the anterior chamber. However, on April 29, 2024, the patient returned with complaints of ”moving shadows” in her right eye for the past five months. A thorough history revealed that she had intermittently noticed shadows in her vision three months post-surgery, which persisted for seven months without associated symptoms such as redness or pain.A B-scan ultrasound performed at this visit indicated vitreous opacities. Anterior segment photography illuminated an active lipid droplet-like foreign body in the anterior chamber (Fig. 1C), leading to a diagnosis of foreign body in the anterior chamber of the right eye. On July 3,2024, the patient underwent anterior chamber irrigation at our facility. Preoperative examination revealed a visual acuity of 0.3, intraocular pressure of 11 mmHg, and 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 (Fig. 1D). The density of corneal endothelial cells in the right eye is 673.8/mm²(Fig.1B). The surgical procedure was performed as follows (Appendices containing Supplementary Video): 1. The patient was placed in a supine position with routine disinfection and sterile draping of the surgical site. 2. A lid speculum was used to maintain eyelid openness, while 1% povidone-iodine solution was utilized to cleanse the conjunctival sac. 3. Topical anesthesia was administered with proparacaine. 4. A 3.0 mm clear corneal incision was made at both the 10 o’clock and 2 o’clock positions. 5. A viscoelastic agent was introduced to the anterior chamber to push the foreign body to the incision site, and forceps were used to pick up and collect the foreign body following its expulsion. 6. The corneal incision was secured to ensure watertight closure. 7. Postoperative medication included levofloxacin and Diclofenac sodium ointment. Postoperatively, her visual acuity remained at 0.3, with a clear cornea and a well-positioned intraocular lens. Postoperative follow-up one week later showed no abnormalities in the right eye with maintained visual acuity of 0.3. The foreign body retrieved during surgery was subsequently sent for mass spectrometry analysis at Tianjin Medical University School of Pharmacy. The results indicated the presence of dexamethasone, confirming its origin as the tobramycin-dexamethasone ointment applied after surgery (Fig.2). Furthermore, the spectrum analysis for tobramycin exhibited lower ion peak responses, possibly attributable to a small sample volume or the rapid metabolic clearance of tobramycin(Fig.2). Discussion: The review of previous literature (Table 1) indicates that ocular ointments in the anterior chamber not only adversely impact visual acuity and overall patient experience but may also contribute to a decrease in the destiny of corneal endothelial cells, potentially leading to complications such as endothelial decompensation, iridocyclitis, glaucoma, and macular edema [2-4, 10-19] . Basic experimental research shows that endothelial decompensation can develop over time [5] . Therefore, we recommend that patients seek prompt removal of any identified anterior chamber foreign bodies. Lipid droplets were observed in the patient’s anterior chamber eight months postoperatively. This may be attributed to the initial small size of the lipid droplets entering the anterior chamber, allowing them to gradually merge into a detectable droplet. Additionally, the patient’s posture may have permitted the lipid droplets to remain behind the iris, thus rendering them undetectable in the anterior chamber. 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 due to negative pressure created by the removal of the speculum, 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. In cases of low intraocular pressure, the wound can begin to open from within towards the periphery. For standard watertight clear corneal incisions, normal or elevated intraocular pressure can help prevent wound leakage. In experiments conducted by Sarayba et al., the researchers employed human cadaver eyes and Indian ink to demonstrate the flow of ink into the anterior chamber through corneal incisions when intraocular pressure was lowered to 5 mmHg. Additionally, they observed that in three eyes with baseline intraocular pressures 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 [6] . Consequently, transient postoperative hypotony may be one driving force behind the entry of ocular ointments into the corneal incision. According to records from the FDA regarding Tobramycin-Dexamethasone ointment, each gram contains the following active ingredients: Tobramycin 0.3% (3 mg) and Dexamethasone 0.1% (1 mg), along with preservatives such as chlorobutanol 0.5%, and inactive ingredients including mineral oil and white petrolatum. 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) [7] . In experiments by Harold et al., mineral oil was injected into rabbit eyes, observed as small, freely moving spheres. After two weeks, corneal endothelial cell loss was noted in regions exposed to mineral oil. Similarly, the injection of petrolatum into rabbit eyes resulted in complete endothelial cell loss in the areas contacted by petrolatum within four weeks [5] . Yao et al. have confirmed through animal studies that the combination of dexamethasone with glucose can effectively treat postoperative corneal edema without a reduction in endothelial cell counts [8] . Retrospective studies have suggested that intravitreal injections of the combination of dexamethasone and moxifloxacin (Vigadexa®) show no toxicity to corneal endothelial cells after anterior chamber injection following phacoemulsification [9] . Thus, we can conclude that the primary contributors to the reduction of corneal endothelial cells are the white petrolatum and mineral oil present in Tobramycin-Dexamethasone ointment. Recommendations for Prevention and Management: 1. Surgeons must recognize the importance of maintaining a watertight closure of the corneal incision and proper suturing techniques following cataract surgery. The removal of the speculum should be performed gently, and the quantity of ocular ointment used must be minimized. Pressure bandages should be avoided postoperatively, and patients should be clearly instructed to refrain from rubbing or pressing on their eyes [2] . 2. During the first postoperative examination, clinicians should carefully inspect the anterior chamber for any foreign bodies, including the possibility of ocular ointment that may be hiding behind the iris; prompt removal of any foreign bodies is imperative. 3. If the intraocular lens has not been contaminated by the ocular ointment, mydriatic agents should be avoided during surgery to reduce the risk of lens contamination. 4. Surgical techniques may include a double incision technique similar to that used in cataract extraction, with viscoelastic agents injected on one side while employing a blunt suction cannula to remove the contents from the other side [10] .It can also be extracted by gently pressing the back edge of the main incision. Summary The presence of ocular ointments 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. Acknowledgements Thank you to Professor Linyi Dong from the School of Pharmacy at Tianjin Medical University for your assistance in analyzing the components of the lipid droplet. Statement of Ethics Study approval statement: This case report did not require Research Ethics Board approval according to the the Ethics Committee of Tianjin Eye Hospital: Ethical Conduct for Research Involving Humans. Consent to publish statement: Informed consent was obtained in writing from the patient for publication of the details of their case and any accompanying images. Conflict of interest statement The authors have no conflicts of interest to declare. Funding information This study was not supported by any sponsor or funder. 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. 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. References: 1. Moshirfar M, Milner D, Patel BC. Cataract Surgery. 2023 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644679. 2. Humayun M, Gottlieb CC, Rafuse PE. Intraocular ophthalmic ointment following clear corneal phacoemulsification: Clinical implications. J Cataract Refract Surg. 2006 Dec;32(12):2135-8. doi: 10.1016/j.jcrs.2006.08.034. PMID: 17137997. 3. Werner L, Sher JH, Taylor JR, Mamalis N, Nash WA, Csordas JE, Green G, Maziarz EP, Liu XM. Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery. J Cataract Refract Surg. 2006 Feb;32(2):227-35. doi: 10.1016/j.jcrs.2005.12.093. PMID: 16564997. 4. Kudo A, Kudo T, Takahashi D, Metoki T, Suzuki Y, Nakazawa M. Macular edema associated with intraocular ointment after cataract surgery. Am J Ophthalmol Case Rep. 2018 Mar 2;10:152-155. doi: 10.1016/j.ajoc.2018.02.027. PMID: 29780926; PMCID: PMC5956708. 5. SCHEIE HG, RUBENSTEIN RA, KATOWITZ JA. OPHTHALMIC OINTMENT BASES IN THE ANTERIOR CHAMBER. CLINICAL AND EXPERIMENTAL OBSERVATIONS. Arch Ophthalmol. 1965 Jan;73:36-42. doi: 10.1001/archopht.1965.00970030038009. PMID: 14220603. 6. Sarayba MA, Taban M, Ignacio TS, Behrens A, McDonnell PJ. Inflow of ocular surface fluid through clear corneal cataract incisions: a laboratory model. Am J Ophthalmol. 2004 Aug;138(2):206-10. doi: 10.1016/j.ajo.2004.03.012. PMID: 15289128. 7. Kamrani P, Hedrick J, Marks JG, Zaenglein AL. Petroleum jelly: A comprehensive review of its history, uses, and safety. J Am Acad Dermatol. 2024 Apr;90(4):807-813. doi: 10.1016/j.jaad.2023.06.010. Epub 2023 Jun 12. PMID: 37315800. 8. Yao, L., & Hong, B. (2014). Application of anterior chamber injection of dexamethasone in modern cataract extracapsular extraction with intraocular lens implantation. Chinese Journal of Drugs and Clinical Practices, 14(09), 1233-1234. 9. Galvis V, Prada AM, Tello A, Parra MM, Camacho PA, Polit MP. Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery. Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3215-3221. doi: 10.1007/s00417-023-06095-0. Epub 2023 May 25. PMID: 37227478; PMCID: PMC10587335. 10. Sanders RN, Warner DB, Adams LR, Sallam AA, Uwaydat SH. Ocular Complications from Retained Intraocular Ointment Discovered 33 Months after Cataract Surgery. Case Rep Ophthalmol. 2018 Dec 11;9(3):493-498. doi: 10.1159/000495002. PMID: 30687069; PMCID: PMC6341354. 11. Aralikatti AK, Needham AD, Lee MW, Prasad S. Entry of antibiotic ointment into the anterior chamber after uneventful phacoemulsification. J Cataract Refract Surg. 2003 Mar;29(3):595-7. doi: 10.1016/s0886-3350(02)01503-1. PMID: 12663030. 12. Riedl M, Maca S, Amon M, Nennadal T, Kruger A, Barisani T. Intraocular ointment after small-incision cataract surgery causing chronic uveitis and secondary glaucoma. J Cataract Refract Surg. 2003 May;29(5):1022-5. doi: 10.1016/s0886-3350(03)00060-9. PMID: 12781294. 13. Chew JJ, Werner L, Mackman G, Mamalis N. Late opacification of a silicone intraocular lens caused by ophthalmic ointment. J Cataract Refract Surg. 2006 Feb;32(2):341-6. doi: 10.1016/j.jcrs.2005.07.018. PMID: 16565014. 14. Lin J, Si S. Unknown droplets floating in the anterior chamber angle. Asian J Surg. 2023 Nov;46(11):4979-4980. doi: 10.1016/j.asjsur.2023.06.029. Epub 2023 Jul 4. PMID: 37414680. 15. Wong JG, Bank A. Surgical removal of intraocular antibiotic ointment after routine cataract phacoemulsification. J Cataract Refract Surg. 2006 May;32(5):890-2. doi: 10.1016/j.jcrs.2006.01.071. PMID: 16765812. 16. Shukla AN, Daly MK, McKnight CJ, Freddo T. Intraocular ophthalmic ointment following anterior segment surgery. J Cataract Refract Surg. 2011 Dec;37(12):2218-21. doi: 10.1016/j.jcrs.2011.09.015. Epub 2011 Oct 17. PMID: 22001107. 17. Mansour AM, Haddad RS, Salti HI, Habbal Z. Optical Coherence Tomography Findings in Anterior Chamber Ointment Globule after Phacoemulsification. Case Rep Ophthalmol. 2015 Dec 19;6(3):469-76. doi: 10.1159/000442970. PMID: 26955351; PMCID: PMC4777953. 18. Katabami Y, Sakata R, Honjo M, Numaga J. [Foreign Body in the Anterior Chamber 10 Months after Uneventful Cataract Surgery]. Nippon Ganka Gakkai Zasshi. 2016 Apr;120(4):310-5. Japanese. PMID: 27209860. 19. Mohamed-Noriega K, Guerra-Lorenzo F, Mohamed-Noriega J, Villarreal-Mendez G, Morales-Wong F, Mohamed-Hamsho J. Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report. Int J Surg Case Rep. 2022 May;94:107029. doi: 10.1016/j.ijscr.2022.107029. Epub 2022 Apr 3. PMID: 35405515; PMCID: PMC9006328. Tables Table 1: Summary of literature on intraocular ointment complications. Anil K.V. Aralikatti 2003 AMO SA-40N 1d 1d No No Anterior chamber flushing and IOL exchange Martin Riedl 2003 NA (b) 5w 6m Glaucoma Uveitis 4m、 6m Drug induced hypotension，anterior chamber flushing and anterior vitrectomy Muhammad Humayun 2006 LX10BD 1d NA No No Follow-up LX10BD 1d NA No No Follow-up LX10BD 1d NA No No Follow-up LX10BD 1d NA No No Follow-up Liliana Werner 2006 LI61U 12d 4m Corneal edema Elevated IOP (c) 1w PKP (d) ,IOL exchange and second PKP LI61U 5d 3m No No IOL exchange LI61U 7d 3w Elevated IOP Corneal edema 1w Washout of anterior chamber Vitrectomy PKP and IOL exchange LI61U 1d 1.5m No No YAG (e) on the oily material IOL exchange LI61U 1d 2m No No Aspiration of bubble and polishing of IOL LI61U 2m 8m Corneal edema 1d PKP and IOL exchange LI61U 5d 7d Corneal edema Elevated IOP 1d Anterior vitrectomy and washout of AC Trabeculectomy Glaucoma valve PKP and IOL exchange LI61U 1d 6d No No Aspiration of bubble and polishing of IOL James G. Wong 2006 SA60AT 2m 2m No No IOL exchange Jesse J.L. Chew 2006 SI-30NB 18m 25m 19m 26m Inflammation in the anterior chamber 8m Diagnostic–therapeutic irrigation/aspiration and IOL exchange Shukla AN 2011 SA60AT 2.4y 2.4y Chronic cystoid macular edema 1w Removal of the foreign substance and anterior chamber washout Mansour AM 2015 NA 3w NA Cystoid macular edema Endothelial cell loss 3w Removed NA 1d 30m Corneal edema Epithelial defects 18m Ointment removed with application of an amniotic membrane. Katabami Y 2015 NA 10m 10m No No Removed the foreign body Riley N. Sanders 2018 NA 33m 33m Macular edema Corneal endothelial decompensation 33m、39m Anterior chamber washout and sub-Tenon injection of triamcinolone Asaka Kudo 2018 Acrysof IQ®, Alcon 11m 15m Macular edema, uveitis Decreased corneal endothelial cell density Vitreous opacity 14m Ointment removed and anterior chamber irrigated Mohamed-Noriega K 2022 Bausch & Lomb, ADAPT-AO 1d 7m Toxic anterior segment syndrome Endothelial cell density loss 1d Anterior chamber irrigation and aspiration Jiateng Lin 2023 NA 3d 6d No No Anterior chamber irrigation a:IOL:intraocular lens; b:NA:not available;c:IOP:intraocular pressure; d:PKP :penetrating kerato plasty;e:YAG:Yttrium-Aluminum Garnet Laser Capsulotomy Figure legends Figure 1 Ophthalmological examination of the case . A.&B . Corneal endothelial cell density pre- and post-surgery. C. Ocular appearance. D .OCT imaging of the anterior chamber. Figure 2 Mass spectrometry analysis of dexamethasone and tobramycin. A .Mass spectrometry analysis of dexamethasone:From top to bottom are 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. Mass spectrometry analysis of tobramycin. From top to bottom are blank (methanol), standard ointment, and sample. The ion peak of the measured sample has a low response value to the ion peak of tobramycin. Appendices Surgical video of the ointment removal process. Supplementary Material File (tables.docx) Download 19.41 KB Information & Authors Information Version history V1 Version 1 19 May 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords antibiotics drug analysis infectious diseases mass spectrometry ophthalmology Authors Affiliations Xuan Li 0000-0003-1052-4222 [email protected] Tianjin Eye Hospital View all articles by this author Hanlu Liu 0009-0004-8405-7414 Tianjin Medical University View all articles by this author Xiafei Chen 0009-0004-7147-7559 Tianjin Medical University View all articles by this author Zhongxu Ma View all articles by this author junmei Lu Nankai University View all articles by this author Metrics & Citations Metrics Article Usage 224 views 150 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Xuan Li, Hanlu Liu, Xiafei Chen, et al. Detection of Antibiotic Ointment in the Anterior Chamber and Analysis of Related Issues Following Phacoemulsification Cataract Surgery. Authorea . 19 May 2025. 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