title: Identification of unknown intraocular material after cataract surgery: evaluation of a potential cause of toxic anterior segment syndrome.
abstract: OBJECTIVE
  To describe and identify unknown opaque material between the optic of an AR40 intraocular lens (IOL) injected with the Emerald Series implantation system (both AMO, Inc.) and the posterior capsule at the conclusion of routine phacoemulsification to prevent an outbreak of toxic anterior segment syndrome (TASS).
  
  
  METHODS
  Ambulatory care center operating room, University of North Carolina Hospitals and Department of Ophthalmology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina, USA.
  
  
  METHODS
  After coaxial phacoemulsification in multiple patients, opaque material was present between the optic of a posterior chamber IOL and the posterior capsule. Although there was no TASS, the material was removed from 2 eyes and analyzed with scanning electron microscopy (SEM) and x-ray microanalysis (XRM). Similarly, crystalline lens, Klenzyme (Steris Corp.), Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%), and Provisc (sodium hyaluronate 1.0%) were analyzed.
  
  
  RESULTS
  On SEM, the material had an irregular undulating surface similar to that of Provisc. Viscoat and the crystalline lens had smoother surfaces. On XRM, the material contained sodium, chlorine, and calcium, like Viscoat and Provisc, and phosphorous and sulfur, like Viscoat. The material also contained silicone, magnesium, aluminum, titanium, iron, and zinc. Klenzyme had smaller peaks of sodium, chlorine, and calcium and a higher carbon background than the unknown material.
  
  
  CONCLUSIONS
  The material was likely ophthalmic viscosurgical device that was chemically and structurally altered by the cleaning and sterilization process. The silicone and metallic elements were probably from the Emerald Series implantation system as the disposable cartridge is coated with silicone and the reusable injector is metal.
authors.affiliation: Department of Ophthalmology, Microscopy Services Laboratory, University of North Carolina at Chapel Hill, School of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina 27599-7040, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Mathys
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cohen
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bagnell
mesh_terms: D000869:Anterior Eye Segment / Q000737:chemistry* / Q000648:ultrastructure; D002807:Chondroitin / Q000009:adverse effects / Q000032:analysis*; D002809:Chondroitin Sulfates; D004338:Drug Combinations; D004577:Electron Probe Microanalysis; D005549:Foreign-Body Reaction / Q000139:chemically induced / Q000175:diagnosis*; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000032:analysis*; D007903:Lens Capsule, Crystalline / Q000737:chemistry* / Q000648:ultrastructure; D019654:Lens Implantation, Intraocular; D008855:Microscopy, Electron, Scanning; D018918:Phacoemulsification; D011183:Postoperative Complications; D013577:Syndrome; D014606:Uveitis, Anterior / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D004338:Drug Combinations; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D006820:Hyaluronic Acid; D002807:Chondroitin; D002809:Chondroitin Sulfates