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Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification.

PURPOSE: To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. SETTING: A private practice, with statistical evaluation at a university department. METHODS: Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. RESULTS: The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. CONCLUSIONS: Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.

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Efficacy of anterior chamber decompression in controlling early intraocular pressure spikes after uneventful phacoemulsification.

PURPOSE: To determine the efficacy of anterior chamber decompression in the management of intraocular pressure (IOP) spikes in the early period after uneventful phacoemulsification. SETTING: Royal Free Hospital, Department of Ophthalmology, Royal Free and University College London Medical School, London, United Kingdom. METHODS: This prospective case series comprised 11 consecutive patients with otherwise healthy eyes who an IOP of at least 40 mm Hg 4 to 6 hours after phacoemulsification. After anterior chamber decompression, the IOP was measured at 0, 15, 30, 45, and 60 minutes or until it exceeded 40 mm Hg. RESULTS: The mean IOP 4 to 6 hours postoperatively was 47.09 mm Hg +/- 7.92 (SD) (range 40 to 68 mm Hg). After decompression, the IOP dropped significantly to a mean of 4.73 +/- 3.00 mm Hg at 0 minutes (P<.001) and then increased progressively to 23.36 +/- 10.80 mm Hg at 15 minutes (P<.001), 33.82 +/- 11.74 mm Hg at 30 minutes (P=.005), 35.00 +/- 6.53 mm Hg at 45 minutes (P=.015), and 38.50 +/- 2.51 mm Hg at 60 minutes (P=.041). CONCLUSIONS: Marked IOP spikes developed in eyes without glaucoma or ocular hypertension after uneventful phacoemulsification. Anterior chamber decompression immediately lowered IOP, but the effect was transient.

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Quality-of-life and visual function assessment after phacoemulsification in an urban indian population.

PURPOSE: To assess patients' quality of life (QoL) and overall visual function (VF) after phacoemulsification with intraocular lens (IOL) implantation in an urban Indian population. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. METHODS: This prospective study comprised 300 patients with a mean age of 60.8 years +/- 9.2 (SD) who were evaluated preoperatively for visual acuity, QoL, VF, and demographic information. Postoperative evaluations included the same parameters with the addition of patient satisfaction. Also analyzed was the impact on the resumption of routine daily activities and professional work after phacoemulsification. Patients were divided into 2 categories: driving and nondriving. They were also categorized by profession and type and density of cataract. The relationship of patients' characteristics and QoL versus VF was determined by an analysis of variance and 99% confidence intervals. Effect sizes (change/difference / the standard deviation at baseline) were computed for intergroup longitudinal changes and intergroup differences. RESULTS: Correlation analysis showed a highly significant positive correlation between logMAR scores with VF and QoL. Overall, VF changed more significantly than QoL in effect size on all subscales. Postoperatively, 13% of respondents reported difficulty performing routine work; 40% resumed their daily activities within 1 week and 55%, within 1 month. More than 42% resumed professional activities within 1 week after surgery; 53% took 1 week to 1 month. Eight-six percent were fully satisfied with the results of cataract surgery. Overall, 88% reported that VF and QoL were "a lot better" and 10% responded little they were "a little better" than before surgery. CONCLUSIONS: Improvement in health-related QoL and VF occurred within 3 months of cataract extraction. The speed of visual acuity recovery after phacoemulsification matched the improvement across health-related QoL functions, resulting in rapid recovery of the patients' functional independence and health status.

Activities of Daily Living↗

Retinal detachment after phacoemulsification cataract extraction.

PURPOSE: To estimate the incidence of retinal detachment (RD) after phacoemulsification cataract extraction in an unselected group of patients. SETTING: Herlev University Hospital, Copenhagen, Denmark. METHODS: This retrospective review comprised 6521 cataract patients who had phacoemulsification over a 3-year period. The incidence of postoperative RD and the risk factors were assessed. RESULTS: During the 15- to 52-month observation period, 22 cases of RD in 21 patients were observed, with an estimated risk (Kaplan-Meier) of 0.41% (95% confidence limit, 0.25%-0.57%) at 52 months. The results confirmed recognized preoperative risk factors for RD such as an axial length greater than 25.0 mm (P<.001), age younger than 65 years (P<.001), and male sex (P<.02). In 18 eyes, the retina was reattached after 1 operation. CONCLUSIONS: The incidence of RD after phacoemulsification cataract extraction in an unselected group of patients was low. A long axial length, young age, and male sex were confirmed as risk factors.

Adult↗

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia.

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.

Acrylic Resins↗

Results of phacoemulsification in eyes with preexisting glaucoma filters.

PURPOSE: To evaluate the intraocular pressure (IOP), best corrected visual acuity (BCVA), and glaucoma medication requirements in patients having phacoemulsification after preexisting glaucoma filters. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis of 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or a scleral tunnel (26 eyes) approach after filtration surgery was performed with a minimum follow-up of 12 months. Two-tailed homoscedastic t tests were used for statistical analysis. RESULTS: The mean preoperative IOP in all eyes was 11.8 mm Hg +/- 4.2 (SD), and the mean final postoperative IOP was 13.7 +/- 4.6 mm Hg (P<.022). The mean preoperative logMAR equivalent BCVA was 0.8 +/- 0.4, which improved to a mean of 0.4 +/- 0.4 postoperatively (P<.0000002). There was no statistically significant change in glaucoma medication requirements postoperatively. The differences in IOP, BCVA, and postoperative glaucoma medication requirements were not statistically significant between the clear corneal group and the scleral tunnel group or between patients who received mitomycin at the time of filtration surgery and those who did not. There were no intraoperative complications; 1 patient required additional glaucoma surgery. CONCLUSION: Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medicines required for IOP control over a minimum follow-up of 1 year.

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Prednisolone and flurbiprofen drops to maintain mydriasis during phacoemulsification cataract surgery.

PURPOSE: To compare the effects on the pupil of pretreatment with prednisolone 1% eyedrops, flurbiprofen 0.03% eyedrops, and sodium chloride 0.9% eyedrops in patients having phacoemulsification cataract surgery. SETTING: Christopher Home Eye Unit, Royal Albert Edward Infirmary, Wigan, United Kingdom. METHODS: One hundred thirty-six white patients having phacoemulsification with no history of eye disease, antiinflammatory medication, or diabetes were enrolled in this prospective randomized double-blind study. Patients were allocated to receive flurbiprofen 0.03%, prednisolone 1%, or sodium chloride 0.9% (placebo) eyedrops at 30-minute intervals beginning 2 hours before surgery. All patients received cyclopentolate 1% and phenylephrine 2.5% drops preoperatively and epinephrine 1:10(6) intraoperatively in the intraocular irrigating solution. The pupil diameter was measured from a television screen at the preset magnification of the operating microscope immediately before the incision, at the end of nucleus emulsification, at the end of irrigation/aspiration (I/A), and at the end of surgery. One hundred twelve patients with a baseline pupil diameter of at least 6.0 mm who had uneventful phacoemulsification were analyzed. RESULTS: The baseline pupil diameters were statistically similar. An analysis of variance did not reveal an overall significant mydriasis-maintaining effect of prednisolone or flurbiprofen compared to the placebo at any stage of surgery (P =.16 to.37). The 95% confidence interval showed flurbiprofen to be superior to prednisolone at the end of surgery. According to the paired t test, the reduction from the baseline at the end of I/A in the prednisolone group (P =.051) and at the end of surgery in the flurbiprofen group (P =.22) was not significant. CONCLUSION: In the presence of epinephrine in the intraocular irrigating solution, both prednisolone 1% and flurbiprofen 0.03% failed to maintain mydriasis at the crucial steps of nuclear emulsification and cortical I/A.

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Feasibility of sleeveless bimanual phacoemulsification with the Millennium microsurgical system.

PURPOSE: To assess the feasibility of sleeveless bimanual phacoemulsification using the Millennium Microsurgical System (Bausch and Lomb Surgical) by measuring wound temperature during phacoemulsification. SETTING: In vitro laboratory. METHODS: The Millennium system was used in 6 eye-bank eyes using pulse mode and 80-milllisecond and 160-millisecond phaco burst mode width intervals. Wound temperatures were measured, and the wounds were observed for thermal injury. RESULTS: In pulse mode and the nonoccluded state at 100% power, the maximum temperature was 43.8 degrees C. In the occluded state at 30% power, the maximum temperature was 51.7 degrees C after 70 seconds of occlusion. In phaco burst mode with a 160-millisecond burst-width interval, the maximum temperature was 41.4 degrees C (nonoccluded at 100% power). At 80% power, the maximum temperature was 53.2 degrees C within 60 seconds of full aspiration occlusion with the footpedal fully depressed. With an 80-millisecond burst-width interval in the nonoccluded and occluded states (100% power, footpedal fully depressed for 3 minutes), there was no significant temperature rise. The maximum temperature was 33.6 degrees C in the nonoccluded state and 41.8 degrees C in the occluded state. In all instances, the corneal wound remained clear. No wound burn or contracture was noted. CONCLUSIONS: The demonstrated temperature rises were under clinically unusual parameters. Phacoemulsification with a sleeveless needle through a small stab incision can be safely performed with the Millennium system using conventional phaco burst mode settings within certain parameters.

Body Temperature↗

Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome.

PURPOSE: To report a series of patients with pseudoexfoliation syndrome who had phacoemulsification without an increased incidence of intraoperative complications or late intraocular lens (IOL) dislocation. SETTING: Department of Ophthalmology, Kaiser Permanente, Denver, Colorado, USA. METHODS: Patients were prospectively recruited from a consecutive series of all cases of phacoemulsification performed by 1 surgeon. There were 67 eyes with pseudoexfoliation syndrome and 1670 eyes without pseudoexfoliation. The incidence of vitreous loss, capsule tears, and zonular dialysis was compared between the 2 groups. RESULTS: The incidence of vitreous loss was 1.5% in eyes with pseudoexfoliation syndrome and 2.3% in eyes without pseudoexfoliation. The difference between the 2 groups was not statistically significant (chi square = 0.203; P =.33). There were no cases of posterior capsule tears or zonular dialysis in pseudoexfoliation eyes without vitreous loss. No IOL dislocated over a mean follow-up of 54.1 months. CONCLUSION: Although caution is still advised, patients with pseudoexfoliation syndrome who have phacoemulsification can achieve results similar to patients without pseudoexfoliation.

Adolescent↗

Intracameral mydriatics in phacoemulsification cataract surgery.

PURPOSE: To evaluate intracameral injection of mydriatics in phacoemulsification cataract surgery and compare the results with those of conventional topical mydriatics. SETTING: Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, Sweden. METHODS: This prospective randomized double-blind study included 60 patients who were given topical (topical group) or intracameral (intracameral group) mydriatics. The topical mydriatics comprised 3 drops of cyclopentolate 1% and phenylephrine 10% given 15 minutes apart and 150 microL intracameral lidocaine hydrochloride 1% (Xylocaine) and the intracameral mydriatics, placebo eyedrops and 150 microL intracameral cyclopentolate 0.1%, phenylephrine 1.5%, and Xylocaine 1%. The pupil size was recorded preoperatively, throughout surgery, and 1 day and 1 month postoperatively. Preoperative and postoperative corneal endothelial morphology, corneal thickness, intraocular pressure, visual acuity, aqueous cells and flare, phacoemulsification energy, duration of surgery, pulse, blood pressure, and intraoperative sensation of pain and glare were also recorded. RESULTS: With intracameral mydriatics, mydriasis reached 95% +/- 3% (SD) of its final value within 20 seconds. In the intracameral group, the pupils were smaller than in the topical group (mean 6.7 +/- 1.0 mm versus 7.7 +/- 1.0 mm, P<.001) but did not contract intraoperatively. The pupils in the topical group tended to contract, and the difference between groups was significant (P =.0020). The intracameral group reported less glare during the procedure (P<.001). There was no difference in endothelial cell loss, inflammatory reaction, postoperative corneal swelling, or surgical performance between the groups. CONCLUSIONS: Intracameral mydriatics were a rapid, effective, and safe alternative to topical mydriatics in phacoemulsification. Their use can simplify preoperative routines and in certain high-risk groups, may reduce the risk for cardiovascular side effects.

Administration, Topical↗

Occurrence and progression of diabetic retinopathy after phacoemulsification cataract surgery.

PURPOSE: To evaluate the risk factors associated with the occurrence and progression of diabetic retinopathy (DR) after phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. METHODS: The medical charts of 52 eyes of 48 consecutive patients who had phacoemulsification were retrospectively reviewed. The occurrence of DR (new development of any DR) and progression (DR requiring laser treatment) were correlated with patients' age, sex, duration of diabetes, control of diabetes, hypertension, ischemic heart disease, and surgical technique. Exclusion criteria were significant ocular conditions and a follow-up shorter than 6 months. RESULTS: The occurrence of DR was associated with male sex, and among males, with the duration of the disease. An analysis including all patients showed that postoperative progression of preexisting DR was not associated with any factor except poor blood sugar control. Neither the occurrence nor progression of DR was associated with reduced visual acuity CONCLUSIONS: The occurrence and progression of DR after phacoemulsification were associated with different factors. Poor systemic control of diabetes increases the risk.

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Posterior capsule rupture and vitreous loss during phacoemulsification with or without the use of an anterior chamber maintainer.

PURPOSE: To compare the incidence of posterior capsule rupture and vitreous loss during phacoemulsification with and without the use of an anterior chamber maintainer (ACM) SETTING: Aristotle University Eye Clinic, Thessaloniki, Greece. METHODS: The surgical records of patients who had phacoemulsification by experienced surgeons over a 2-year period were reviewed. The cases were divided into 2 groups: surgery performed without the use of an ACM (no-ACM group) and surgery performed with the use of an ACM (ACM group). RESULTS: The no-ACM group comprised 231 cases and the ACM group, 312 cases. Posterior capsule rupture occurred in 19 cases (8.22%) and 22 cases (7.05%), respectively. Of the patients with posterior capsule rupture, 6 (31.57%) in the no-ACM group and 16 (72.72%) in the ACM group had vitreous loss and required an anterior vitrectomy; the difference between the 2 groups was statistically significant (P =.03). CONCLUSIONS: The use of an ACM in phacoemulsification provided a consistently deep anterior chamber and approximately the same rate of complications as with a standard technique in the hands of experienced surgeons. However, when posterior capsule rupture occurred, the incidence of vitreous loss was significantly higher in eyes with an ACM.

Aged↗

Visual sensation during phacoemulsification and intraocular lens implantation using topical and regional anesthesia.

PURPOSE: To evaluate patients' visual sensations at different stages of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation under topical and regional anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital and Tseung Kwan O Hospital, Kowloon, Hong Kong, China. METHODS: Seventy-six consecutive patients having phacoemulsification were randomized to a topical anesthesia group (n = 35) or regional anesthesia group (n = 41). The topical anesthesia group received lidocaine hydrochloride 2% gel (Xylocaine) and the regional anesthesia group, a peribulbar or retrobulbar injection of lignocaine 2%. The patients' visual sensations, including light and color sensations, shape of objects, and visual patterns, were evaluated at different stages of surgery. RESULTS: Two patients (4.9%) in the regional anesthesia group and none in the topical anesthesia group experienced total loss of light sensation throughout surgery (P =.50). There was a significant association between color perception and the type of anesthesia at stages 1 and 2 (P<.05) but not at stages 3, 4, and 5 (P>.05). The perception of objects and visual patterns had no association with the type of anesthesia at any stage (P>.05). Of all patients in the study, 56 (73.7%) reported color changes as surgery proceeded. Both groups saw waves, defined as curves with periodic fluctuations in amplitude, at all stages. The perception of some colors and a rectangular moving object was significantly associated with the type of anesthesia at some or all stages (P<.05). CONCLUSIONS: Patients having phacoemulsification and PC IOL implantation under topical or regional anesthesia had a wide spectrum of visual sensations that were similar at most stages of surgery. Patients in the topical anesthesia group perceived more colors at the early stages and more blue throughout surgery than patients in the regional anesthesia group.

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Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident.

PURPOSE: To assess the risk factors for endothelial cell loss after phacoemulsification cataract surgery performed by a junior resident. SETTING: Ophthalmic teaching hospital, Dublin, Ireland. METHODS: This prospective study included 40 eyes having divide-and-conquer phacoemulsification cataract surgery by a junior resident under the supervision of an experienced surgeon. Nine variables were examined to assess the risk for corneal endothelial cell loss postoperatively. RESULTS: The mean overall endothelial cell loss was 11.6%. Longer surgery time, longer absolute and effective phaco time, higher mean ultrasound power, and higher cataract density were significantly associated with endothelial cell loss on univariate analysis. Multivariate analysis identified a grade 3 nucleus (severely dense) and long absolute phaco time as independent predictors for endothelial cell loss, with longer absolute phaco time the stronger predictor. CONCLUSIONS: Divide-and-conquer phacoemulsification cataract surgery was a safe technique in the hands of an ophthalmic trainee. This study supports advice to junior surgeons to choose cases with less dense cataracts as this will help reduce the absolute phaco time and thus minimize endothelial cell loss.

Adult↗

Capsulotomy for phacoemulsification in hypermature cataracts.

We describe a modified surgical technique of anterior capsulotomy and phacoemulsification for use in hypermature cataracts. Surgical steps included inferior linear capsulotomy with aspiration of milky cortex, inflation of the capsular sac with viscoelastic, a reverse triangular anterior capsulotomy with Vannas scissors, and in-the-bag bimanual sculpting of the nucleus. An oval 5 mm x 6 mm posterior chamber intraocular lens was used with single horizontal or no-stitch wound closure. The technique was used successfully in 20 cases of hypermature cataract. The mean time required to perform phacoemulsification was 3.46 minutes (range 1.2 to 6.3 minutes), with a standard deviation of 1.29. Visual acuity on the first postoperative day ranged from 20/20 to 20/60 (median 20/40). At one week, the mean astigmatism was 1.01 diopters (range 0.25 to 2.75 diopters). The mean endothelial cell loss was 13% (range 3.6% to 26.0%). Based on our results, the modified phacoemulsification technique merits consideration for use in hypermature cataracts.

Adult↗

Topical anesthesia for phacoemulsification: initial 20-case series with one month follow-up.

We report the results of our initial 20 phacoemulsification cases performed using topical anesthesia. The preferred topical regimen consisted of preservative-free 0.75% bupivacaine. Intravenous sedation was provided primarily with fentanyl and midazolam. Phacoemulsification was performed through a scleral tunnel incision, and a one-piece poly(methyl methacrylate) or three-piece silicone intraocular lens was implanted. There were no complications with the anesthetic technique. One day postoperatively, 69% of patients with a desired refractive error within 0.75 diopters of emmetropia had an uncorrected visual acuity of 20/40 or better. At one month, all patients had a best corrected acuity of 20/30 or better, and 60%, 20/20 or better. Eighteen patients reported complete intraoperative comfort, and 17 reported complete postoperative comfort. Seven of the 10 patients who had had previous peribulbar anesthesia preferred topical. All 10 "first eye" patients said they would choose topical anesthesia for future surgery. With appropriate case selection, topical anesthesia for phacoemulsification surgery can be used with excellent intraoperative and postoperative results.

Anesthesia, Local↗

Combined phacoemulsification, intraocular lens implantation, and trabeculectomy.

PURPOSE: To analyze the results of phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: John Moran Eye Center, University of Utah, Salt Lake City. METHODS: Two hundred twelve eyes of 174 patients with glaucoma and cataracts were analyzed retrospectively after cataract removal by phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. RESULTS: With an average follow-up of 26 months, patients had a significant improvement in visual acuity. The preoperative mean intraocular pressure (IOP) of 23.1 mm Hg decreased postoperatively to 15.9 mm Hg. Mean number of glaucoma medications decreased from 1.85 preoperatively to 0.41 postoperatively. Twenty-one patients (10% had a postoperative IOP of greater than 21 mm Hg, and seven required trabeculectomy revisions. CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy yielded excellent results in the treatment of patients with both cataract and glaucoma.

Adult↗

Intraocular metallic-appearing foreign bodies after phacoemulsification.

Intraocular metallic-appearing foreign bodies in the anterior segment were seen in six eyes after cataract extraction by two-handed phacoemulsification. These fragments produced no symptoms and had no clinically significant effect on visual function. Similar-appearing foreign bodies were experimentally produced by applying ultrasound power with a phacoemulsification handpiece to the surface of a cyclodialysis spatula in vitro. Microscopic examination of the phaco handpiece tip and cyclodialysis spatulas revealed numerous surface irregularities, suggesting a possible source of these fragments. These results suggest that instrument touch during phacoemulsification may be the cause of the fragments. Long-term follow-up of these patients is required to determine the overall effect of the fragments.

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