Retained Lens Fragments

Abstract

We read the Hui et al article1Hui J.I. Fishler J. Karp C.L. et al.Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.Ophthalmology. 2006; 113: 1949-1953Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar on the clinical features and treatment of retained nuclear fragments in the anterior chamber (AC) with great interest, having recently managed a patient with this problem.Our patient presented in a manner similar to that described by the authors, with inferior corneal edema and AC inflammation, but only at a subsequent visit 12 weeks postoperatively was a retained lens fragment noted in the AC.Hui et al also noted an association between retained lens fragments and patients with myopia, long axes, and/or steep keratometry readings. This was indeed the case with our patient, whose preoperative refraction was −12 diopters (D), with an axial length of 26.09 mm and mean keratometry readings of 44.76 D.The only point we would question is the recommendation that patients be given pilocarpine preoperatively. We initially regretted not doing this, because having identified the lens fragment in the AC immediately before the operation, it had passed through to the posterior chamber (PC) by the time the patient was on the operating table. However, after dilation with intracameral mydriatic, we found 2 retained lens fragments in the PC.If these large myopic eyes are prone to harboring lens fragments, it may be sensible to dilate the pupil to ensure that there are no additional fragments in the PC. In our case, if we had constricted the pupil preoperatively, we would have missed a second lens fragment, potentially resulting in refractory inflammation and corneal decompensation. We read the Hui et al article1Hui J.I. Fishler J. Karp C.L. et al.Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.Ophthalmology. 2006; 113: 1949-1953Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar on the clinical features and treatment of retained nuclear fragments in the anterior chamber (AC) with great interest, having recently managed a patient with this problem. Our patient presented in a manner similar to that described by the authors, with inferior corneal edema and AC inflammation, but only at a subsequent visit 12 weeks postoperatively was a retained lens fragment noted in the AC. Hui et al also noted an association between retained lens fragments and patients with myopia, long axes, and/or steep keratometry readings. This was indeed the case with our patient, whose preoperative refraction was −12 diopters (D), with an axial length of 26.09 mm and mean keratometry readings of 44.76 D. The only point we would question is the recommendation that patients be given pilocarpine preoperatively. We initially regretted not doing this, because having identified the lens fragment in the AC immediately before the operation, it had passed through to the posterior chamber (PC) by the time the patient was on the operating table. However, after dilation with intracameral mydriatic, we found 2 retained lens fragments in the PC. If these large myopic eyes are prone to harboring lens fragments, it may be sensible to dilate the pupil to ensure that there are no additional fragments in the PC. In our case, if we had constricted the pupil preoperatively, we would have missed a second lens fragment, potentially resulting in refractory inflammation and corneal decompensation. Author replyOphthalmologyVol. 115Issue 2PreviewWe thank Drs Goodfellow and Whitefield for their insightful comments. Full-Text PDF