Comparison Of Nd:Yag Laser And Anterior Chamber Washout For The Treatment Of Retained Lens Fragments After Phacoemulsification

The presence of retained lens fragments (RLF) in the anterior chamber (AC) after phacoemulsification may be associated with delayed visual rehabilitation and potential corneal endothelial damage. This study aimed to assess the safety and efficacy of Nd:YAG laser treatment for RLF in the AC refractory to medical therapy and to compare its outcomes with anterior chamber washout (ACW).

This study was conducted at the Department of Ophthalmology of a tertiary referral center in Turkey.

This retrospective study included patients with RLF in the AC after uncomplicated phacoemulsification treated with ACW (n=21) or Nd:YAG laser (n=13). Primary outcomes were treatment success, final best-corrected visual acuity (BCVA), and corneal endothelial parameters by specular microscopy at 6 months post-treatment. Treatment success was classified as complete (complete RLF resolution with a single intervention, no complications), qualified (complete RLF resolution requiring additional intervention or with medically manageable complications), or failure (complications with measurable visual acuity loss).

Demographic and ophthalmic characteristics, including cataract grade, RLF type, and size, were comparable (p>0.05). In the ACW group, complete success was achieved in 15 eyes (71.4%), qualified success in 3 (14.2%), and failure in 3 (14.2%), including two cases of pseudophakic bullous keratopathy (PBK) and one intraoperative cerebrovascular event. In the Nd:YAG group, complete success occurred in 9 eyes (69.2%) and qualified success in 4 (30.7%). Although treatment success did not differ significantly (p>0.05), final BCVA was significantly better in the Nd:YAG laser group (p=0.039). Despite the exclusion of two PBK cases, median endothelial cell density remained significantly lower in the ACW group (1227.0 vs 1994.0 cells/mm²,p=0.018).

While clinical success rates were comparable between the two approaches, Nd:YAG laser was associated with significantly superior visual outcomes and better endothelial preservation. In selected cases of RLF, Nd:YAG laser may represent a minimally invasive, endothelial-sparing alternative to surgical treatment.