Intraocular deposition of metallic fragments during phacoemulsification: Possible causes and effects

Abstract

SUMMARYWe undertook a prospective slit lamp examination of 56 eyes which had undergone routine phacoemulsification, in order to determine the incidence of metallic intrao The use of phacoemulsification in cataract surgery is increasing in the United Kingdom. The post operative finding of intraocular metal particles has long been recognised, such particles having been considered inert. 1 , 2 We attempted to examine and quantify this phenomenon, in the light of recent interest in 'metallosis' and the bioreactivity of titanium alloy. 3 -8 PATIENTS AND METHODS Clinical StudyFifty-four consecutive phacoemulsification patients (56 eyes) were studied. The phacoemulsification equipment contained a Venturi pump with two piezo-electric crystals operating at 28 kHz. The diameter of the needle barrel and the width of the phacoemulsification tunnel were 1 mm and 3.2 mm respectively.All patients were examined within 2 weeks of surgery by slit lamp biomicroscopy. Using maximum illumination and magnification, the iris stroma was examined with an angled beam (45°) directed first from the right and then the left. The patient's eye was examined in the primary position and then in upgaze and in downgaze. Particles often glinted when illuminated from one direction only. The number and position of particles were recorded by a single observer (CM.D.). Study of Phacoemulsification NeedlesTwelve phacoemulsification needles were examined under the operating microscope and the pattern of wear recorded by colour photography. One new and four used needles were further examined using a J eol JSM-35CF scanning electron microscope operating at 12 kV. RESULTS Clinical StudyFifty-six eyes of 54 patients were studied; average patient age was 73.4 years and the male to female ratio was 17 to 37. All operations were performed at Aberdeen Royal Infirmary by one of four consul tants.Metallic particles were noted in 48 eyes (86%). The number per eye ranged from 1 to 103 with a mean of 5.1. Only the largest reflected sufficient light to appear on a slit lamp photograph (Fig. 1). Many appeared no larger than a white blood cell. Particles appeared to be randomly distributed over the iris stroma, often within crypts. No accompanying clinical problems were seen. Under the reduced Eye (1995) 9, [434][435][436]

Retained fragments in the anterior segment following phacoemulsification surgery

“…These have mainly concerned lens fragments 4,5 or metallic foreign bodies. 6,8 Our case is unusual in that the source of the foreign bodies was the inner lining of the sleeve, which covered the phacoemulsification tip. On close examination the lining looked irregular and there were small white particles which appeared to be floating away from the sleeve.…”

Unilateral amiodarone keratopathy: occlusive contact lens spares development in the contralateral eye

“…Patients on amiodarone are known to develop photosensitivity and cutaneous pigmentation. 1,4 We propose that the occlusive contact lens and the resultant lack of exposure to ultraviolet light prevented the keratopathy in the contralateral eye. In a previous case series, asymmetrical AK was reported in a patient with unilateral ptosis.…”

Large metallic fragment found in the angle of anterior chamber after phacoemulsification, and its removal

“…Sir, Unilateral amiodarone keratopathy: occlusive contact lens spares development in the contralateral eye Amiodarone, a diiodinated benzofuran derivative, is used to treat patients with atrial and ventricular arrhythmias and angina pectoris. 1,2 Its use has been associated with numerous side effects including pulmonary fibrosis, thyroid dysfunction, gastrointestinal problems, neuropathy, dermatopathy, and ocular effects. 1,[3][4][5] Ocular changes caused by amiodarone may involve the lens, the retina, the optic nerve, and more commonly the cornea.…”

“…1,2 Its use has been associated with numerous side effects including pulmonary fibrosis, thyroid dysfunction, gastrointestinal problems, neuropathy, dermatopathy, and ocular effects. 1,[3][4][5] Ocular changes caused by amiodarone may involve the lens, the retina, the optic nerve, and more commonly the cornea. 3,[5][6][7] Amiodarone keratopathy (AK) has a prevalence of 70-100%, but only 10% of patients experience visual disturbances.…”