Conservative management appropriate for some retained lens fragment cases

This letter published in the November issue of the Journal of Cataract & Refractive Surgery discusses how soft retained lens material can go away with conservative topical anti-inflammatory treatment but at the cost of many endothelial cells. Removal of significant dense chips is appropriate.

Adriano Guarnieri, MD, and colleagues wrote this letter in response to a case of corneal edema resulting from retained lens material 8.5 years after phacoemulsification that was reported in the same journal in June 2011. They agree with the article’s authors that this complication is more frequent than published reports suggest, noting that it could be related to surgical procedures or intraoperative complications in which cortical lens material is left in the periphery of the capsular bag (e.g, pupillary miosis).

They report seeing similar cases and describe one, in which a patient with Marfan syndrome who had undergone extracapsular cataract extraction without intraocular lens implantation at age 11 suddenly developed inferior corneal edema in the right eye 24 years later. Fragments of lens material were found in the anterior chamber. Because the patient had lost the left eye due to a prior retinal detachment, she refused surgery in the right eye. After two months of topical steroid treatment, the lens fragments dissolved completely and CDVA improved to 20/20. However, the endothelial cell count decreased from 2,744 cells/mm2 before the onset of corneal edema to 1,624 cells/mm2 afterward.

The letter’s authors suggest removal of retained lens fragments to reduce endothelial damage but say that a conservative approach may be an option in some cases, especially those involving soft lens material. They note that endothelial cell count change is related to the duration of corneal edema and the hardness of the lens material. They recommend the use of endothelial microscopy to determine the management of these cases and say that patients who refuse surgery should be advised of the possibility of endothelial damage, especially in cases involving retained hard lens material.