Official ESCRS | European Society of Cataract & Refractive Surgeons


Retained anterior chamber lens fragments after cataract surgery: what are the risk factors?

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Session Details

Session Title: Presented Poster Session: Combined Cataract Surgery & Cataract Surgery Complications

Venue: Poster Village: Pod 1

First Author: : S.Naylor UK

Co Author(s): :    R. Darbyshire                       

Abstract Details


Although rare, a retained lens fragment in the anterior chamber (AC) following uncomplicated cataract surgery may give rise to significant post-operative morbidity. This includes chronic anterior uveitis, cystoid macular oedema, secondary glaucoma and corneal decompensation.  Further surgical intervention including fragment removal, corneal endothelial grafting and administration of peri-ocular steroid may be indicated. Study aims: 1. To quantify the incidence of retained lens fragment requiring removal following routine cataract surgery 2. To identify risk factors 3. To quantify post-operative morbidity: types of further surgical intervention required and best corrected post-operative visual acuity (BCVA)


A retrospective observational case-control study was performed in a single centre, secondary care setting. Data has been obtained from patients undergoing routine cataract surgery in the outpatient ophthalmic service.


Cataract surgery data from 2010 onwards was extracted from the Medisoft database including: age, sex, pre-operative VA, biometry, pupil size, use of surgical adjuncts, IOL, effective phacoemulsification time (EPT) and ocular co-morbidity.  Cases of retained fragment removal were identified.  Statistical analysis of cases versus control was performed using the Open Source Epidemiologic Statistic Resource for Public Health.  Dichotomous data was analysed by calculation of risk ratio and mid-P exact.  For continuous data a two sample independent t-test with a 95% confidence interval was used with assessment of variance using Hartley’s f test for equality of variance.


62 cases required retained lens fragment removal from 60,724 routine cataract surgeries (incidence 0.001%). There was a significant difference in mean EPT between cases (11.31 ± 9.43 seconds) and controls (7.76 seconds ± 8.60, P =0.01).  Risk ratios of IC phenylephrine and pseudoexfoliation were 3.6 (P < 0.01) and 5.6 (P = 0.03) respectively. Average time from initial surgery to lens fragment removal was 31 days (range 0-124).  2 cases required corneal endothelial grafting and 2 patients with chronic macular oedema received peri-ocular steroid. Post-operative BCVA compared to pre-operative was improved in 75.8%, equivalent in 6.5% and worse in 11.3%.


With an incidence of 0.001%, retained lens fragment is a very rare complication of cataract surgery. Increased risk associated with IC phenylephrine is likely related to smaller pupil size or intra-operative floppy iris syndrome, whilst increased EPT may represent increased propensity for denser cataracts to release nuclear chips.   All cases self-presented, suggesting presence of these risk factors would not alone be an indication for post-operative review.  The 3.2% rate of refractory corneal oedema is similar to other available literature. Prognosis after fragment removal is good with over 75% achieving an improvement in BCVA.

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