Retained Lens Fragments After Phacoemulsification
The incidence of posteriorly displaced, or retained, lens fragments ranges from 0.3%–1.1% in reported series. Retained lens fragments may cause severe intraocular inflammation and secondary glaucoma. Nuclear fragments usually continue to cause chronic intraocular inflammation, whereas cortical remnants usually spontaneously reabsorb (Table 20-1).
Table 20-1 General Recommendations for Management of Retained Lens Fragments
Indications for vitrectomy include secondary glaucoma, lens-induced uveitis, and the presence of large nuclear fragments. In the 4 largest reported series, 52% of patients with retained lens fragments had an IOP of at least 30 mm Hg before vitrectomy. Removal of the lens fragments reduced this incidence by 50% or more in these series. Pars plana vitrectomy, with or without use of a fragmatome, is the preferred approach to remove harder pieces of the lens nucleus (Video 20-5). Following lens fragment removal, the retinal periphery should be examined for the presence of retinal tears or retinal detachment.
VIDEO 20-5 Vitrectomy for removal of retained lens fragment.
Courtesy of Colin A. McCannel, MD.
Reported studies with long-term follow-up have found that retinal detachment occurs in about 15% of eyes with retained lens fragments. Aggressive attempts to retrieve posterior lens fragments using a limbal approach are sometimes complicated by retinal detachments caused by giant retinal tears. Giant retinal tears are more commonly found 180° away from the incision used for cataract surgery.
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Aaberg TM Jr, Rubsamen PE, Flynn HW Jr, Chang S, Mieler WF, Smiddy WE. Giant retinal tear as a complication of attempted removal of intravitreal lens fragments during cataract surgery. Am J Ophthalmol. 1997;124(2):222–226.
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Modi YS, Epstein A, Smiddy WE, Murray TG, Feuer W, Flynn HW Jr. Retained lens fragments after cataract surgery: outcomes of same-day versus later pars plana vitrectomy. Am J Ophthalmol. 2013;156(3):454–459.
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Vanner EA, Stewart MW. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis. Am J Ophthalmol. 2011;152(3): 345–357.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.