Diagnosis Of Retained Lens Matter Following Phacoemulsification Surgery

This study examines the incidence, clinical presentation, timing of diagnosis, and visual outcomes of retained lens matter (RLM) following  phacoemulsification (phaco) surgery at a tertiary centre.  

Primary outcomes were to identify the time to diagnosis and washout in cases of RLM, and to report on the incidence of anterior uveitis, corneal oedema and cystoid macular oedema (CMO) at diagnosis and after anterior chamber washout. The secondary objective was to assess the prevalence of retained lens matter in uncomplicated cases versus those with posterior capsule rupture (PCR). 

This was a retrospective analysis conducted at Moorfields Eye Hospital, London. 

All cases of non-combined phacoemulsification surgery with subsequent irrigation of anterior chamber between 1st October 2015 and 17th October 2025 were retrieved. Data collected from electronic medical records included: date of cataract surgery, diagnosis of retained lens matter and washout; VA at baseline, diagnosis of retained lens matter and following washout; location of lens matter; ocular history, presence of anterior uveitis, corneal oedema and CMO after phacoemulsification, and refractory anterior uveitis or CMO after washout; and complications during phacoemulsification surgery and need for further vitrectomy. 

Of 173,639 eligible phaco procedures, 258 cases of RLM were identified (0.148%). Of all RLM cases, 24 (9.30%) followed a PCR. RLM occurred in 1.6% of PCR cases vs 0.13% of uncomplicated cases. RLM location was most commonly anterior chamber (82.2%, n=212), angle (6.59%, n=17) and in the bag (4.26%, n=11). Median time from phaco to RLM diagnosis was 27.5 days (range 0-1299) and tonAC washout 37 days (range 1-1326).  Anterior uveitis occurred in 55.8% (n=144), corneal oedema in 30.6% (n=79), CMO in 8.91% (n=23), and 22.5% (n=58) were asymptomatic. Median time to RLM diagnosis was 37.5 days with uveitis, 52.5 days in CMO, 23 days in corneal oedema and 25 if asymptomatic. Post-washout uveitis persisted in 13.6% (n=35), and CMO in 9.30% (n=24). 

Retained lens matter was an uncommon complication of phacoemulsification. Most cases occurred without PCR, although the presence of a PCR was associated with a markedly higher risk. Clinical presentation was variable, and many patients were asymptomatic at diagnosis. Time to RLM diagnosis differed between examination findings, possibly representing different indexes of suspicion for RLM in differing circumstances. These findings highlight the importance of careful postoperative assessment in all patients after cataract surgery, symptomatic or not.