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Case Reports and Small Case Series
May 1999

A Retained Intraocular Surgical Needle 2 Years After Cataract Extraction

Arch Ophthalmol. 1999;117(5):691. doi:

Cystoid macular edema (CME) occurs not infrequently after cataract extraction.1 Various theories exist as to the cause of this phenomenon, including vitreous traction on the macula and uveal inflammation causing a disruption of the blood-retina barrier. Persistent irritation to the iris and anterior uvea may serve to promote or exacerbate this condition, and in part may help explain the observation that CME occurs more frequently in patients with anterior chamber intraocular lenses (IOLs) as compared with patients with posterior chamber IOLs.1,2 In this report we describe a patient with a retained intraocular suture needle after cataract extraction, in association with chronic CME unresponsive to medical therapy.

Report of a Case.

A 90-year-old patient was seen at our service 2 years after a cataract extraction and IOL placement. He had had poor vision since his surgery. His ocular history was otherwise unremarkable, and his medical history was significant for diet-controlled diabetes mellitus.

His best-corrected visual acuity was 20/400 OD and 20/50 OS. His pupils, extraocular motility, and ocularadnexa were normal. Slitlamp examination of his right eye showed scattered deposits on the corneal endothelium consistent with previous inflammation, a well-placed anterior chamber lens, and a metallic foreign body between the IOL and the iris at the 3-o'clock position (Figure 1). Examination results of his left eye were only remarkable for a moderate nuclear sclerotic cataract. Intraocular pressures were normal in both eyes. Dilated fundus examination showed severe chronic CME in his right eye, and this was confirmed with fluorescein angiography.

Figure 1.
Slitlamp photograph showing the retained intraocular needle located between the iris and the anterior chamber lens at the 3-o'clock position.

Slitlamp photograph showing the retained intraocular needle located between the iris and the anterior chamber lens at the 3-o'clock position.

Given the long-standing CME and its poor response to topical steroid and nonsteroidal anti-inflammatory agents, the patient was offered pars plana vitrectomy as well as removal of the foreign body. A standard 3-port pars plana vitrectomy was performed. The superotemporal sclerotomy was then enlarged slightly with a microvitreoretinal blade. An intraocular forceps was then inserted through the superotemporal sclerotomy and passed anteriorly through the pupil. With upward pressure on the posterior surface of the IOL, the foreign body was grasped and withdrawn. Further inspection of the foriegn body showed it to be a needle to a 10-0 suture (Figure 2). Postoperatively, the patient was prescribed topical steroids and antibiotic drops and cycloplegia was maintained. The macular edema improved and he had a visual acuity of 20/160 OD after 4 weeks of follow-up.

Figure 2.
Photograph of surgical needle after its removal from the anterior chamber. It appears to be the needle to a 10-0 suture. The needle was bent during surgical removal.

Photograph of surgical needle after its removal from the anterior chamber. It appears to be the needle to a 10-0 suture. The needle was bent during surgical removal.

Comment.

While the patient was at risk for CME given his complicated cataract surgery and anterior chamber IOL, chronic uveal irritation from an intraocular needle may have served as an aggravating factor. Fortunately, retained needles occur uncommonly in surgical practice and, to our knowledge, are unreported after intraocular surgery. Metal fragments, however, have been found in the anterior chamber after phacoemulsification, presumably left behind by the phaco tip.3 The physiological consequence of these retained particles is not known.

In summary, retained surgical needles may occur after intraocular surgery and may be associated with a poor visual outcome. Removal of retained surgical material may be indicated in selected cases.

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Article Information

This study was supported in part by the Vitreoretinal Research Fund (Dr D'Amico).

Corresponding author: Bradley S. Foster, MD, 275 Bicentennial Hwy, Springfield, MA 01118 (e-mail: bfoster2@aol.com).

References
1.
Blair  MPKim  SH Cystoid macular edema after ocular surgery. Albert  DMJakobiec  FAPrinciples and Practice of Ophthalmology Philadelphia, Pa WB Saunders Co1994;898- 906
2.
Stark  WJ  JrMaumenee  AEFagadau  WDatiles  MBaker  CCWorthen  DKlein  PAuer  C Cystoid macular edema in pseudophakia. Surv Ophthalmol. 1984;28442- 451Article
3.
David  PLMastel  D Anterior chamber metal fragments after phacoemulsification surgery. J Cataract Refract Surg. 1998;24810- 813Article
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