You are a resident doing cataract surgery and when you try to withdraw your chopper from the paracentesis, the tip gets caught in the incision and then breaks off. Now this sharp metal fragment is sitting on the iris. What is your next move?
If the tip of your chopper instrument breaks off inside the eye during cataract surgery, first maintain anterior chamber stability and avoid sudden or forceful movements. Pause the procedure and carefully locate the fragment under the microscope using coaxial lighting. If the tip is visible and freely mobile in the anterior chamber, use micro-forceps or another instrument through a paracentesis to gently retrieve it through the main incision. If the fragment is embedded in the capsule or displaced posteriorly, avoid aggressive attempts at removal to prevent further damage. Complete the case with minimal manipulation, ensuring the IOL is securely placed. If the fragment cannot be retrieved safely, consider a retinal consultation. After surgery, examine the broken piece and the chopper to ensure that no other metal fragments are in the eye. A replay of the video while you are still in the operating room can help as well.