Intraoperative Fracture of Phacoemulsification Tip
Phacoemulsification with intraocular lens (IOL) implantation in the left eye was performed in a 61-year-old female. Preoperatively, the best-corrected visual acuity (BCVA) was 20/200. The patient had grade II nuclear sclerosis with grade II cortical cataract in the left eye. Intraocular pressure (IOP) was 14 mmHg, and no other significant ocular abnormality was noted.\nSurgery was performed under topical anesthesia with 2% Xylocaine gel. A 2.75 mm temporal clear corneal incision was made with a keratome. Continuous curvilinear capsulorrhexis, hydrodissection and hydrodelineation were performed without complications. Phacoemulsification was then performed using a standard 20-gauge ABS (Aspiration Bypass System) phaco tip (Infiniti, Alcon laboratories, Inc., Fort Worth, TX, USA). As soon as the phaco tip was inserted into the nucleus, the surgeon realized there was no vacuum build up and carefully evaluated the problem. The phaco parameters were verified to be appropriate. The same steps were repeated, however it was noted that a segment of the titanium tip was broken. The broken fragment remained inside the silicone sleeve []. The phaco probe was carefully taken out ensuring the removal of the phaco needle with the broken end in toto. The anterior chamber (AC) was reformed with viscoelastic and a thorough search for any potential fragments under the operating microscope did not reveal any residual material. The surgery was completed uneventfully with a new titanium tip. Thereafter, we meticulously examined the broken tip under the operating microscope [-]. The broken ends matched perfectly with no missing fragments, thus confirming no retained foreign body within the AC. It was noted that the tip had broken in the area where the ABS microhole was present (i.e., 3 mm from the distal open end). Electron microscopy (EM) of the broken ends revealed a smooth break near the microhole of the ABS tip [-]. The postoperative course was uneventful, and the patient achieved BCVA of 20/25 with normal IOP and a quiet AC at 3 months postoperatively.