Unexpected Intracameral Foreign Bodies During Regular Cataract Surgeries

Unexpected intracameral foreign bodies during regular cataract surgery appear relatively often but seem to be underreported, since they are almost often immediately removed. They rarely remain in the anterior chamber and can be the source of inflammation, infections, or lead to corneal endothelial decompensation. We report two series of cases with different materials of different origins and review the literature.

During several cases of uncomplicated phacoemulsifications under topical anesthesia, unknown foreign bodies visibly flushed in through the sleeve of the phaco handpiece. The material was always removed and submitted to the (Eidgenössische Materialprüfungs- und Forschungsanstalt; Federal Institute for Materials Testing and Research) for further investigations.

Spectral analysis revealed that, in our cases, the foreign bodies were remnants of otherwise intact phaco sleeves that had not been cleaned properly during production. In another case series, the resin granules from the water filtration system for the instrument washing machine had found their way into the phaco handpieces.

Many shapes and materials of different origins might unexpectedly appear during cataract surgery in the eye. Their immediate extraction is necessary, as they might cause corneal endothelial damage, chronic inflammation, or could be the source of infections. Vigilance reporting is also important for the controlling medicinal organizations and companies to assure early recognition of systematic problems.