Anterior chamber metal fragments after phacoemulsification surgery

Abstract

Purpose: To determine whether metal fragments can be shaken loose from phaco needles during surgery and embed in the iris. Setting: Private practice, Vernon, British Columbia, Canada, and scanning electron microscope laboratory, Mastel Precision, Rapid City, South Dakota, USA. Methods: The surfaces and rims of new and used phaco needles and the lumens of halved new needles were examined by scanning electron microscopy (SEM). To determine whether the fragments on the phaco needles were approximately the same size as those seen in the iris, a photograph of an eye with metal fragments imbedded in the iris was projected and the image size of the metal fragments approximated by using their magnification value. The magnification scale of the SEM images was used to determine the’size of the metal fragments photographed on the phaco needles. Results: The SEM studies of new phaco needles revealed tiny fragments of metal firmly adherent to the interior, exterior, and rim surfaces. No fragments were detected on the surfaces of the used phaco needles. Two metal fragments in the eye photograph were calculated to be 0.20 × 0.20 mrr and 0.15 × 0.20 mm. Those in the SEM photos were calculated to be 0.03 to 0.10 mm. Conclusion: Although SEM of new titanium phaco needles revealed adherent metal fragments on their lathed surfaces, no fragments were found on used phaco needles. The iris fragments calculated, from a projected photograph were slightly larger than those from the SEM micrographs, supporting the conclusion that annealed metal fragments shook loose from the phaco needles. This indicates that ultrasonic activation of a new phaco needle with metal fragments annealed to its surface causes fragments to release and embed in the iris.