These small particles appeared in the anterior vitreous during what appeared to be a routine and uncomplicated cataract surgery. The patient had a prior history of trauma and was noted to have a small area of zonular loss of about 1 clock hour. The cataract surgery went beautifully with phaco chop used to remove the cataract and then the single-piece acrylic IOL placed in the capsular bag. There was no need for a capsular tension ring since the zonular weakness was limited. The capsulorhexis overlaps the optic and the lens is held securely in position.
The fine particles that are seen in the anterior vitreous are tiny cataract pieces that have washed into the anterior vitreous through the area of zonular loss. Fortunately, these pieces are all quite small and do not require an additional procedure to remove them. There is expected to be more inflammation in the post-operative period, but within just a few weeks, this should resolve.
Could this have been prevented? Perhaps we could have placed a small bolus of dispersive viscoelastic at the area of zonular loss to act as a plug. But the fluidic motion during the surgery could wash the viscoelastic away. Either way, it does not pose much of an issue. This can also happen in eyes without zonular loss because the high infusion pressure can, in some cases, push fluid through.
