Asteroid Hyalosis Migration into the Anterior Chamber during Cataract Surgery

A 70-year-old male presented for cataract surgery in the right eye with pre-operative assessment significant for nuclear sclerotic cataract and asteroid hyalosis. Upon irrigation and aspiration during cataract surgery, yellow-white spheres consistent with asteroid hyalosis were visualized circulating into the anterior chamber despite an intact capsule and no apparent zonular weakness. The asteroides particles were completely aspirated by the irrigation and aspiration ports, and an intraocular lens was implanted into the capsular bag. Postoperatively, the patient did well with final visual acuity of 20/20 and no vitreous prolapse, retinal tears, or detachments noted. There are only four cases in the literature of asteroid hyalosis migrating in the anterior chamber; none of these cases are associated with migration during intraocular surgery. We hypothesize that the asteroid hyalosis migrated anteriorly and around the zonules due to the synuretic nature of the vitreous and microscopic gaps in the zonular fibers. This case demonstrates the importance of the cataract surgeon to be aware of potential migration of asteroid hyalosis into the anterior chamber during surgery.