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Microplastics exposures in cataract surgery and potential clinical concerns
Summary
Scientists found tiny plastic particles called microplastics in people's eyes during cataract surgery, with higher amounts in patients who had diabetes or other eye problems. The plastic pieces were already inside the eye before surgery started, suggesting they came from everyday exposure rather than from the surgical tools themselves. This discovery raises concerns about how microplastics might affect eye health, though more research is needed to understand if they cause harm.
Microplastic (MP) exposures have been a significant global public health concern. Cataract surgery is the most frequently performed ocular surgery worldwide, and various plastic tools are used in cataract surgery. This study aimed to evaluate the characteristics of MPs in surgical devices, intraocular fluids, and cataractous crystalline lenses in cataract surgery. We collected surgical solutions/devices (irrigation saline, balanced salt solution [BSS], and ophthalmic viscosurgical device [OVD]), ocular inflow/outflow fluids from six phacoemulsification cases, cataractous crystalline lenses from two extracapsular cataract extraction patients, and operating room (OR) air samples. Numbers and characteristics of MPs were measured using raman spectroscopy and surface morphologies of MPs were measured using scanning electron microscopy with energy dispersive spectroscopy. There were no MPs in saline or BSS in syringes nor in OVD. A small number of MPs were detected in ocular inflow fluids (mean ± standard deviation [SD] = 0.1 ± 0.1/mL) and OR air (mean ± SD = 0.5 ± 0.3/mL). Higher concentrations were observed in intraocular outflow fluid, with one plastic bag-collected sample showing 50.4 ± 0.3/mL, compared with 1.5(± 1.4)-7.2(± 3.5)/mL in other patients whose samples were collected in glass containers. MPs were also detected in cataractous crystalline lens (mean ± SD = 12.3 ± 5.8/100 mg). Ocular inflow fluids contained only 10-19 μm polyethylene (PE) and polypropylene (PP) fragments. However, intraocular outflow fluids and cataractous crystalline lenses contained smaller 5-9 μm fragments and fibers of six polymer types: PE, PP, polystyrene (PS), polycarbonate (PC), polyethylene terephthalate (PET), and polyamide (PA). Patients who had other ocular diseases within past three years or who had diabetes at the time of surgery showed higher concentrations of total MPs and PE (P < 0.05). MPs can be exposed into eyeball during cataract surgery, potentially from surgical instruments or indoor air. Substantial intraocular MP contamination exists prior to surgery rather than from external surgical sources.