Patient characteristics and outcomes of retained lens fragments in the anterior chamber after uneventful phacoemulsification

Purpose To determine patient characteristics and outcomes for developing retained nuclear fragments in the anterior chamber after phacoemulsification in at-risk populations. Setting University of Arkansas for Medical Sciences, Jones Eye Institute, Little Rock, Arkansas, USA. Design Retrospective case series. Methods Using Current Procedural Terminology codes 2006 to 2018, patients with a diagnosis of retained nuclear fragment in the anterior chamber after uncomplicated phacoemulsification cataract extraction were identified. Patient demographics, ocular biometrics, treatments, and clinical management were recorded. Main outcome measures were visual outcomes and visual acuity at regular follow-up appointments. Results Nineteen patients (13 with myopia) were identified. Most patients (n = 15) presented with corneal edema and anterior chamber inflammation, and the fragments were diagnosed on slitlamp examination in most patients (n = 18). Seventeen retained fragments were found in the inferior angle. The mean axial length, keratometry, and anterior chamber depth (ACD) values were 23.58 mm, 44.93 diopters, and 2.97 mm, respectively. The mean time from cataract extraction to fragment removal was 34.7 days. The final corrected distance visual acuity ranged from 20/20 to 20/400. Three patients developed cystoid macular edema, and 2 patients had corneal complications after fragment removal. Conclusions A comparison between the patients in this study and cited cases indicates that long eyes, steep corneas, and a shallow ACD might be risk factors for retained nuclear fragments in patients having cataract extraction. Prompt identification and surgical removal provided the best visual outcomes because most cases proved refractory to steroid treatment.