Incidence and complications of retained lens fragment in the anterior chamber after uneventful cataract surgery in a United Kingdom tertiary center. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Matarazzo, Francesco; Phylactou, Maria; Aiello, Francesco; Gallo Afflitto, Gabriele; Yue Sim, Sing; Maurino, Vincenzo
• Is Part Of: Journal of cataract and refractive surgery. Volume 47:Issue 8(2021)
• Page Start: 1064
• Page End: 1070
• Publication Date: 2021-08
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000000585
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : Corrected distance visual acuity improved after retained lens fragment removal although 1 in 20 eyes needed additional surgery for persistent corneal edema. Abstract : Purpose: To analyze the outcomes of retained lens fragment (RLF) in the anterior chamber after uneventful cataract surgery. Setting: Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom. Design: Retrospective, observational cross-sectional study. Methods: A single-center, retrospective review was performed to identify patients who underwent RLF removal after uneventful phacoemulsification surgery between October 2012 and November 2018; 122 eyes from 121 patients were identified. Patient characteristics, clinical findings, visual outcomes, and need for subsequent surgical procedure were recorded. Main outcomes were change in corrected distance visual acuity (CDVA), and number and risk factors associated with additional surgery following RLF removal. Results: One hundred twenty-two RLF over a total of 98 467 uneventful phacoemulsification surgeries were identified, with an incidence of 1 (0.124%) in 807 operations. The mean CDVA improved significantly after RLF removal from 0.32 to 0.26 logMAR (SD 0.26) ( P = .001). Six eyes (4.9%) had persistent corneal edema that required endothelial keratoplasty (EK) after a mean of 13 months after RLF removal (SD 12 months; median 8; range 4 to 35). Risk factors for EK include α-receptor blocker use (odds ratio [OR], 6.75; 95% CI, 1.069, 42.63), increased interval (month) between cataract surgery and diagnosis of RLF (OR, 1.29; CI: 1.080, 1.541), increased interval between cataract surgery and RLF washout (OR, 1.28; CI, 1.075, 1.522), and RLF diagnosis on gonioscopy (OR, 10.60; CI, 1.885, 59.59). Conclusions: RLF is a rare complication of uneventful cataract surgery and appears more frequently in challenging cataract cases and myopic eyes. CDVA improved significantly after RLF removal, but approximately 1 in 20 eyes needed additional surgery–mainly EK for corneal decompensation.