Toxic Posterior Segment Syndrome Following Dropless Cataract Surgery With Compounded Triamcinolone-Moxifloxacin.

BACKGROUND AND OBJECTIVE: This report aims to describe the clinical presentation, outcomes, and prognostic risk factors of toxic posterior segment syndrome (TPSS) associated with a compounded triamcinolone-moxifloxacin formulation administered during dropless cataract surgery (DLCS). PATIENTS AND METHODS: This was a retrospective multicenter case series of 50 eyes with TPSS after DLCS. Data collected included clinical and multi-modal imaging features. Multivariate and ordinal logistic regression models were used to identify factors associated with disease severity. RESULTS: TPSS severity was categorized as mild (n = 14), moderate (n = 14), or severe (n = 22) based on final best-corrected visual acuity (BCVA). Severe cases demonstrated outer retinal thinning with ellipsoid zone (EZ) and external limiting membrane (ELM) loss, disc leakage, and enlarged foveal avascular zone. Ordinal logistic regression showed worse presenting visual acuity (< 20/150; OR 7.00, P < .001) and male sex predicted severe disease (OR 3.22, P < .001), while a normal fluorescein angiography (FA) appearance was protective (coefficient -8.395, P = .001). CONCLUSION: This large case series describes TPSS prognostic risk factors and underscores the urgent need for standardized Food and Drug Administration (FDA)-approved intraocular formulations.