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Trypan Blue Use During Cataract Surgery and Postoperative Fungal Endophthalmitis
Tomohiko Torikai1, Teppei Shimasaki2, Hiroshi Keino1
1Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan.
JAMA Ophthalmology
|May 21, 2026
Summary
A rare outbreak of postoperative fungal endophthalmitis occurred after cataract surgery. Sarocladium kiliense, identified in contaminated trypan blue solution, caused the infections, which were successfully treated with antifungal medications.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Postoperative fungal endophthalmitis following cataract surgery is a rare but serious complication.
- An unusual cluster of six cases linked to Sarocladium kiliense (formerly Acremonium kiliense) emerged after conventional cataract surgery.
Purpose of the Study:
- To investigate an outbreak of postoperative fungal endophthalmitis.
- To identify the causative agent and its source following cataract surgery.
Main Methods:
- Retrospective case series of six patients diagnosed with fungal endophthalmitis after cataract surgery.
- Clinical findings, microbiological cultures (including trypan blue solution), and treatment outcomes were evaluated.
Main Results:
- Sarocladium kiliense was identified as the causative organism in five of six patients.
- The same organism was detected in the trypan blue solution used during surgery, suggesting contamination.
- All patients received antifungal treatment (voriconazole, amphotericin B) and underwent vitrectomy, leading to improved visual acuity and infection control.
Conclusions:
- Contaminated trypan blue solution used off-label during cataract surgery was associated with postoperative fungal endophthalmitis caused by Sarocladium kiliense.
- Prompt diagnosis and comprehensive antifungal treatment are crucial for managing this rare complication.
