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J. Fishler, C.L. Karp, J.I. Hui, S.J. Gedde, M.F. Shuler; Retained Nuclear Fragments in the Anterior Chamber After Uneventful Phacoemulsification . Invest. Ophthalmol. Vis. Sci. 2006;47(13):632.
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Retention of nuclear fragments in the anterior chamber after phacoemulsification is a possible complication of cataract surgery. We review possible factors that may contribute to this complication and discuss treatment.
Retrospective chart review of 16 patients with post–operative anterior segment inflammation after uneventful phacoemulsification who were found to have retained nuclear fragments in the anterior chamber. Patient characteristics, clinical findings, treatment (medical and surgical), and visual outcomes were reviewed.
Most of the patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep K readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Final visual outcomes for the patients without significant, concomitant ocular disease who had lens particle extraction ranged from 20/20 to 20/40. Of the 2 patients without comorbid ocular conditions who underwent penetrating keratoplasty, the final acuities were 20/50 and 20/30.
Myopia may be a risk factor for retention of anterior chamber nuclear fragments following uneventful phacoemulsification. We hypothesize that small fragments may hide in the posterior chamber in these larger eyes. In our series, surgical removal was associated with good final visual outcome in patients without significant, concomitant ocular disease.
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