Purpose: This study aimed to determine the rate of retained metallic intraocular foreign bodies (IOFBs) following torsional phacoemulsification cataract surgery by an experienced surgeon and elucidate related surgical factors, particle origin theories from existing literature, and postoperative visual impact.
Methods: An observational study was conducted on 300 consecutive cases of cataract who underwent torsional phacoemulsification by a single surgeon using two-handed stop-and-chop technique. The incidence of retained IOFBs was observed and correlated with the surgical parameters and the density of cataract.
Results: Retained IOFBs were observed in 6 of 300 (2%) cases operated. These were significantly associated with higher cumulative dissipated energy and the density of cataract, but without impacting final vision.
Conclusion: Phacoemulsification retains inherent risks of metallic particle liberation from ultrasonically stressed instrumentation interacting within confined spaces. However, small retained IOFBs appear visually inconsequential over limited follow-up. Advances in technique, engineering design, and surgical quality control hold promise for further enhancing safety of the procedure.
Keywords: Cataract surgery; Phacoemulsification; intraocular foreign bodies; metallic fragments; phacoemulsification tip fracture.