Delayed appearance and consequences of retained nuclear fragments after uneventful phacoemulsification

Abstract

Abstract: : Purpose:To describe the late appearance of retained nuclear fragments and the ocular complications following uncomplicated phacoemulsification. Methods:Retrospective case series of four patients with late appearance of nuclear fragments who underwent uneventful phacoemulsification with in–the–bag IOL placement. Results:All four patients underwent uncomplicated phacoemulsification with in–the–bag lens placement with no loss of integrity to the posterior capsule. The average age of the patients was 75 years, with one women and three men. The average time period between surgery and the appearance of the nuclear fragment was 12 months (range 3 months to 27 months). Complications of the retained nuclear fragment included corneal edema (2 patients), iritis (4 patients), and cystoid macular edema (1 patient). Previous examinations had not revealed the presence of any retained lens fragments. All patients required surgical removal of the lens fragment. Visual acuity returned to pre–inflammation level in all four patients. Conclusions:Retained nuclear fragments may cause delayed ocular morbidity and should be suspected as an etiology for delayed anterior segment inflammation even after uncomplicated phacoemulsification. Our clinical impression is that retained nuclear fragments following uncomplicated phacoemulsification surgery has increased and may be due to newer techniques and fluid dynamics. Hidden fragments may dislodge into the anterior chamber weeks to months following phacoemulsification and require surgical removal. Careful inspection and brisk irrigation of the anterior segment at the end of surgery is recommended to identify and remove remaining lens fragments.

Keywords: cataract • inflammation • cornea: endothelium