gms | German Medical Science

Purpose: It is the aim of this report to describe 1. the intraoperative and postoperative occurrence of microplastics (MP) associated with cataract surgery, 2. the identification of deposited structures, and 3. the tracing of MP in our surgical environment.

Methods: Eyes with postoperative intraocular MP were followed and in 1 case fibres were surgically removed. MP was identified in raw state by light microscopy (transmission and incident lightening, dark field, phase contrast, interference contrast, polarization, fluorescence), by staining with different dyes, their reaction with chemical solvents, and selected structures by FTIR spectroscopy. Typical signatures of MP could be characterized. The way from textiles to surgical instruments was carefully analysed.

Results: Within 3 years 65 events with MP contamination either of instruments or the anterior chamber (intra- or postoperatively) were documented. In 3 of 4 cases with postoperative intraocular MP a quiet status was observed long-term. In 1 case MP caused chronic anterior chamber inflammation and was associated with cystoid macular oedema, both resolving after surgical fibre removal. Harvested MP consisted mainly of polypropylene or polyethylene, the main components of below mentioned textiles. Tracing analysis revealed that MP released by textiles contaminated the instrument cleaning units by eolian transport and were incompletely removed by filters within instrument cassettes. Substitution of most intensively releasing textiles improved the situation, but did not completely eliminate undesired MP contamination.

Conclusion: The majority of textiles used in typical surgical environments (shirts, trousers, gowns, hoods, masks, table and patients coverage) are produced of polymer plastic fibres. These textiles are capable to deliver MP into the air. Unfortunately, all these textiles are routinely (or for CE certification) only tested for delivery of MP potentially contaminating the respiratory system (10 µm and below) and not for larger structures. We could identify MP structures in instruments and intra-/postoperatively in eyes that underwent cataract surgery. Tracing revealed that MP was deposited into instruments, especially those with low internal diameter, within cleaning units as a consequence of insufficient filter function of instrument cassettes.