Microplastics exposures in cataract surgery and potential clinical concerns
Yun-Hee Choi1, Myung-Sun Song2, Nayoon Park2
1Department of Safety and Health, Wonkwang University, Iksan, South Korea.
Abstract:
Microplastic (MP) exposures have been a significant global public health concern. Cataract surgery is the most frequently performed ocular surgery worldwide, and various plastic tools are used in cataract surgery. This study aimed to evaluate the characteristics of MPs in surgical devices, intraocular fluids, and cataractous crystalline lenses in cataract surgery. We collected surgical solutions/devices (irrigation saline, balanced salt solution [BSS], and ophthalmic viscosurgical device [OVD]), ocular inflow/outflow fluids from six phacoemulsification cases, cataractous crystalline lenses from two extracapsular cataract extraction patients, and operating room (OR) air samples. Numbers and characteristics of MPs were measured using raman spectroscopy and surface morphologies of MPs were measured using scanning electron microscopy with energy dispersive spectroscopy. There were no MPs in saline or BSS in syringes nor in OVD. A small number of MPs were detected in ocular inflow fluids (mean ± standard deviation [SD] = 0.1 ± 0.1/mL) and OR air (mean ± SD = 0.5 ± 0.3/mL). Higher concentrations were observed in intraocular outflow fluid, with one plastic bag-collected sample showing 50.4 ± 0.3/mL, compared with 1.5(± 1.4)-7.2(± 3.5)/mL in other patients whose samples were collected in glass containers. MPs were also detected in cataractous crystalline lens (mean ± SD = 12.3 ± 5.8/100 mg). Ocular inflow fluids contained only 10-19 μm polyethylene (PE) and polypropylene (PP) fragments. However, intraocular outflow fluids and cataractous crystalline lenses contained smaller 5-9 μm fragments and fibers of six polymer types: PE, PP, polystyrene (PS), polycarbonate (PC), polyethylene terephthalate (PET), and polyamide (PA). Patients who had other ocular diseases within past three years or who had diabetes at the time of surgery showed higher concentrations of total MPs and PE (P < 0.05). MPs can be exposed into eyeball during cataract surgery, potentially from surgical instruments or indoor air. Substantial intraocular MP contamination exists prior to surgery rather than from external surgical sources.
Insights
Microplastic (MP) contamination is present in cataract surgery, with higher concentrations found in intraocular fluids and lenses than in surgical tools or air. Pre-existing ocular conditions may increase MP exposure during these procedures.
Area of Science:
- Ophthalmology
- Environmental Science
- Materials Science
Background:
- Microplastic (MP) exposure is a growing global health concern.
- Cataract surgery, the most common ocular surgery, utilizes various plastic instruments, raising questions about potential MP contamination.
- Understanding MP presence in ocular tissues and fluids is crucial for patient safety.
Purpose of the Study:
- To investigate the presence and characteristics of microplastics (MPs) in surgical devices, intraocular fluids, and cataractous crystalline lenses during cataract surgery.
- To identify the types and sizes of MPs found.
- To explore potential correlations between patient health conditions and MP levels.
Main Methods:
- Collection of surgical solutions, devices, ocular inflow/outflow fluids, cataractous lenses, and operating room air samples from cataract surgery patients.
- Analysis of MP presence and characteristics using Raman spectroscopy.
- Assessment of MP surface morphologies via scanning electron microscopy with energy dispersive spectroscopy.
Main Results:
- No MPs were detected in irrigation saline, balanced salt solution (BSS), or ophthalmic viscosurgical devices (OVD).
- Low levels of MPs were found in ocular inflow fluids and operating room air.
- Significantly higher MP concentrations were observed in intraocular outflow fluids and cataractous crystalline lenses, with diverse polymer types identified.
- Patients with prior ocular diseases or diabetes showed higher MP concentrations.
Conclusions:
- Microplastics can enter the eyeball during cataract surgery, potentially originating from surgical instruments or the operating room environment.
- Substantial intraocular MP contamination appears to exist prior to surgery, rather than solely from external surgical sources.
- The presence of various polymer types in lenses and outflow fluids highlights a significant exposure pathway that warrants further investigation.
