Occult anterior-chamber metallic fragment post-phacoemulsification masquerading as chronic recalcitrant postoperative inflammation.

Purpose: To report a case of an occult, metallic, anterior-chamber intraocular foreign body after uneventful phacoemulsification that was masquerading as chronic recalcitrant postoperative inflammation.

Design: Interventional case report.

Methods: A 73-year-old patient was referred to us for recalcitrant anterior-chamber inflammation after uneventful phacoemulsification; the patient presented with visual disturbances, anterior-chamber inflammation, and macular epiretinal membrane with concomitant cystoid macular edema.

Results: After meticulous evaluations and repeated clinical examinations, a metallic intraocular foreign body was discovered on the iris, which was surgically removed and analyzed. Chemical analysis revealed copper, aluminum, and zinc. Pars plana vitrectomy with epiretinal membrane and indocyanine-green-assisted internal limiting membrane peeling followed, with subsequent improvement of visual acuity.

Conclusions: Intraocular foreign bodies should always be considered in the differential diagnosis of recalcitrant inflammation post-phacoemulsification. However, in the absence of intraocular inflammation, surgical removal of such particles is questionable.