Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy

We would like to make an observation regarding the patients in the medical therapy group in the article by Schaal et al.1 Twenty percent (n = 3) of the patients in this group had a dropped lens fragment larger than 50% of the lens and 47% (n = 7) had a fragment 25% to 50% of the lens. Retained nuclear fragments in the vitreous cavity produce significant intraocular inflammation, which may lead to secondary glaucoma, media opacities, and cystoid macular edema.2 While in the case of small nuclear fragments, inflammation and glaucoma may resolve on absorption of lens fragments, this is unlikely in cases with large fragments, which may take a long time to absorb or have to be surgically removed. Although the authors mention that visual acuity in the medical therapy group increased significantly by the end of 1 month of follow-up and was maintained up to 1 year, it is not clear how long the medical therapy was continued. Long-term medical therapy is not without risks, and chronic low-grade intraocular inflammation may compromise final visual outcome. Also, marked intraocular inflammation can manifest in eyes with retained lens fragments even after 1 year of medical therapy, once treatment is discontinued.3