• Users Online: 42607
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 83-84

Instrument debris-related fibrinous uveitis after pediatric cataract surgery

Department of Ophthalmology, Sheffield Children's Hospital, Sheffield, United Kingdom

Date of Web Publication15-Feb-2013

Correspondence Address:
Hibba Abdulkarim
Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.107207

Rights and Permissions

How to cite this article:
Abdulkarim H, Rogers NK, Salvi SM. Instrument debris-related fibrinous uveitis after pediatric cataract surgery. Indian J Ophthalmol 2013;61:83-4

How to cite this URL:
Abdulkarim H, Rogers NK, Salvi SM. Instrument debris-related fibrinous uveitis after pediatric cataract surgery. Indian J Ophthalmol [serial online] 2013 [cited 2024 Feb 26];61:83-4. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2013/61/2/83/107207

Dear Editor,

Retained foreign matter introduced perioperatively is believed to play a causative role in postoperative intraocular inflammation in uncomplicated surgery. [1] Processed reusable ophthalmic instruments, and particularly lens introducers, have been shown to retain debris such as denatured viscoelastic and are a major source of retained foreign matter. [2] We present a case of postoperative fibrinous anterior uveitis presumed secondary to debris transferred from the lens introducer onto the intraocular lens implant (IOL).

A 9-year-old boy underwent uncomplicated cataract surgery for juvenile cataract associated with hypoparathyroidism-related-hypocalcemia. Left-sided surgery was performed first, and an AcrySof MA60AC (22 Dioptre) standard lens was inserted. The child had an uneventful postoperative recovery. Right eye cataract surgery was done a month later, and an AcrySof SN60WF (24 Dioptre) lens (blue light filter IOL) was implanted due to a change in the model of IOL used by the hospital. Both IOLs were folded and then inserted using John Weiss lens introducer (model number 0109163).

Two weeks post-right cataract surgery, despite excellent compliance, the patient developed photophobia and ache in the right eye during tapering of topical steroids. When he presented, his right visual acuity was reduced to 20/40 (from 20/25 one week postoperatively). Slit lamp examination revealed anterior uveitis and fibrin deposits closely related to crystalline debris seen on the anterior surface of the IOL [Figure 1]. The debris was noted to be in the configuration of the contact surfaces of the lens introducer used during surgery. The fibrinous anterior uveitis was treated aggressively with topical steroids (1% prednisolone acetate) and resolved completely within three weeks. The debris marks on the IOL persisted without causing any further effects. No uveitis or debris was noted in the left eye.
Figure 1: Slit lamp photograph of the anterior segment of the right eye showing crystalline debris transferred from lens folder onto the anterior surface of the IOL with surrounding secondary fibrinous uveitis

Click here to view

We believe the debris on the IOL played a causative role in the postoperative fibrinous uveitis in this patient. Although causality is not certain, the alignment of the fibrin strands to the debris strongly suggests this. The delay in presentation may have been due to partial treatment of the inflammation by the tapering postoperative topical steroids.

A potential confounding factor is that the patient received a tinted IOL in the right eye only. Beauchamp et al. demonstrated a higher rate of postoperative inflammation observed in pediatric eyes, which received the tinted AcrySof SN60AT IOL in comparison to non-tinted AcrySof SA60AT IOL. [3] However, this is unlikely to explain our findings as the localized fibrin deposits on the IOL indicated a focal inflammatory trigger and not a generalized one such as a tint chromophore.

This case highlights the issue of retained foreign matter on processed ophthalmic instruments, which could precipitate vigorous post-operative inflammation, if deposited intraocularly. We support the suggestion of Dinakaran et al. that instruments are inspected under the microscope by the surgeon prior to use, and that special attention must be paid to contact surfaces.

  References Top

Wadood AC, Dhillon B. Unidentified foreign objects in the wound after clear corneal tunnel phacoemulsification. J Cataract Refract Surg 2002;28:2238-9.  Back to cited text no. 1
Dinakaran S, Kayarkar VV. Debris on processed ophthalmic instruments: A cause for concern. Eye 2002;16:281-4.  Back to cited text no. 2
Beauchamp CL, Stager DR Jr, Weakley DR Jr, Wang X, Felius J. Surgical findings with the tinted AcrySof intraocular lens in children. J AAPOS 2007;11:166-9.  Back to cited text no. 3


  [Figure 1]

This article has been cited by
1 Retained surgical items: Building on cumulative experience
Brett Styskel, Brian Wernick, RonnieN Mubang, StevenM Falowski, ThomasJ Papadimos, StanislawP Stawicki
International Journal of Academic Medicine. 2016; 2(1): 5
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Figures

 Article Access Statistics
    PDF Downloaded162    
    Comments [Add]    
    Cited by others 1    

Recommend this journal