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An uncommon case of ocular hypertension and metallic fragment deposits after phacoemulsification

Poster Details

First Author: D.Lopes PORTUGAL

Co Author(s):    T. Loureiro   S. Parreira   I. Machado   N. Campos           

Abstract Details


To report a case of ocular hypertension possibly caused by metal dispersion of the phaco tip in the anterior chamber after a dense cataract surgery.


Garcia de Orta Hospital


A 46 years-old man with history of glaucoma (controlled with brinzolamide/timolol fixed combination b.i.d.) and high myopia presented an intraocular pressure of 46 mmHg one day after un uncomplicated cataract surgery of the right eye, except for a metal dust visible during the phacoemulsification. Biomicroscopy revealed moderated anterior chamber inflammation and metal dust particles imbedded in the iris. Gonioscopy revealed an open and normal-appearing angle. A side port drainage was performed but one week after the cataract surgery the IOP was still too high (42 mmHg).


We added monoprost q.d., brimonidine q.d. and acethazolamide t.i.d. to the therapy. After 2 days the IOP was 34 mmHg, so we decided to perform a simple two-port anterior chamber washout and after 1 week the IOP was normal (13 mmHg) with the same maximal medical therapy. Six weeks after the surgery he presented a mild hyperemia and anterior chamber inflammation and an IOP of 16 mmHg under treatment with monoprost, brimonidine and brinzolamide/timolol combination. His best corrected visual acuity of the right eye was 20/30.


Post-operative intraocular metallic foreign bodies have been sporadically reported after phacoemulsification surgery. As supported by other studies, the ultrasonic activation and vibration of a phaco needle causes these particles to release and embed in the iris. Although it is mostly agreed that these metallic fragments, mostly constituted by titanium, are well tolerated and rarely migrate, the titanium alloy is not completely inert and their overall effect still remains to be evaluated.

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