Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Majid Moshirfar; Adam L Lewis; James H Ellis; Shannon E McCabe; Yasmyne C Ronquillo; Phillip C Hoopes Sr

doi:10.2147/OPTH.S314148

Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

Clin Ophthalmol. 2021 Jun 21:15:2625-2633. doi: 10.2147/OPTH.S314148. eCollection 2021.

Authors

Majid Moshirfar^{1

2

3}, Adam L Lewis⁴, James H Ellis⁵, Shannon E McCabe^{1

6}, Yasmyne C Ronquillo¹, Phillip C Hoopes Sr¹

Affiliations

¹ Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.
² John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
³ Utah Lions Eye Bank, Murray, UT, USA.
⁴ Kansas City University, Kansas City, MO, USA.
⁵ University of Utah School of Medicine, Salt Lake City, UT, USA.
⁶ Mission Hills Eye Center, Pleasant Hill, CA, USA.

Abstract

Introduction: Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments.

Methods: Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group.

Results: Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years ±6.72 (60-80) compared to 63 ±11.41 (22-86) in the control group (p <0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg ±2.59, 19 mmHg ±8.20, and 11 mmHg ±2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm ±0.37 vs 3.33 mm ±0.39, p = 0.01) and lens thickness (4.77 mm ±0.44 vs 4.35 mm ±0.44, p = <0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 ±40 (1-138).

Conclusion: Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.

Keywords: cataract surgery; complications of cataract surgery; phacoemulsification; refractory corneal edema; retained lens fragments.

Grants and funding

This study was funded by an unrestricted grant from Research to Prevent Blindness (RPB), 360 Lexington Avenue, 22nd Floor New York, NY 10017. No support was received for the publication of this article.