Retained anterior chamber cilium causing endophthalmitis after phacoemulsification

Abstract

An 81-year-old white man had uneventful cataract surgery by an experienced surgeon. Three days postoperatively, he presented with endophthalmitis and was treated in accordance with the standard departmental protocol. During the recovery, a curvilinear foreign body was identified and subsequently removed from the interior anterior chamber. Histological examination confirmed the foreign body as an eyelash. The patient improved to a final corrected visual acuity of 6/9. The relevant literature is reviewed, and ways to prevent this potentially blinding but avoidable complication of intraocular surgery are presented.

Fibres found in the eye during and after phacoemulsification cataract surgery

“…9,14 Eyelashes are also a potential source of fibres. 6,10 It has been suggested that retained fibres may be difficult to detect intraoperatively for several reasons. These include glare from the operating microscope lights on the irrigating solutions, the low contrast afforded to the surgeon by the illumination of certain operating microscopes, and occasionally by obstruction of view through a focally oedematous cornea.…”

“…Current evidence suggests that the majority of retained intraocular fibres cause little or no inflammatory response. 1 In the absence of fibre-related adverse reactions/complications, such as endophthalmitis, 6,9,11,12,15 surgical removal of fibres, found postoperatively, currently remains unjustified.…”

“…[1][2][3][4][5][6][7][8][9][10][11] There are numerous possible mechanisms recognised for the introduction of fibres into the AC. These are documented in Table 1.…”

“…5,6,[10][11][12] Indeed, some fibres are benign and do not appear to cause any inflammatory response from the eye. Others, such as human cilia, may lead to devastating complications such as endophthalmitis.…”

“…Others, such as human cilia, may lead to devastating complications such as endophthalmitis. 6 With the advances in modern cataract surgery, postoperative visual outcomes are generally very good. One important reason for poor vision postoperatively is cystoid macular oedema (CMO).…”