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

Figures & data

Table 1 Patient Characteristics and Management

Pt	Age	Sex	Eye	Cataract	BCVA Pre-Op	Refraction	IOP	AL	ACD	LT	Km	Surgeon	Phaco Technique	Corneal Edema	Fragment Location	Time from CE to Fragment Removal (Days)	BCVA Post-Op	Complications
1	77	F	OD	2+ NS	20/50	+2.00 −0.75 x 093	17	23.29	3.59	N/R	44.8	1	Divide-and-Conquer	2+	Inferior Angle	14	20/20	None
2	71	M	OS	2+ NS	20/100	−0.25 −0.75 x 157	16	24.25	2.89	N/R	42.4	1	Divide-and-Conquer	1+	Inferior Angle	8	20/20	None
3	80	M	OD	2+ NS	20/50	+2.75 −0.75 x 103	17	24.32	3.41	N/R	40.5	1	Divide-and-Conquer	2+	Inferior Angle	14	20/25	None
4	80	M	OD	2+ NS	20/50	+1.00 +1.25 x 055	16	22.91	3.02	N/R	45.1	1	Divide-and-Conquer	1+	Central	9	20/40	None
5	82	F	OD	3+ NS	20/50	−3.5 −1.25 x 125	15	25.20	3.45	N/R	45.4	2	Divide-and-Conquer	2+	Inferior Angle	138	20/100*	None
6	73	M	OD	2+ NS	20/30	+1.00 −0.75 x 120	17	22.69	3.17	N/R	46.0	2	Divide-and-Conquer	1+	Central	1	20/20	None
7	84	M	OD	3+ NS	20/60	−1.25 −3.25 x 095	19	22.62	3.60	N/R	46.4	2	Divide-and-Conquer	2+	Inferior Angle	91	20/30	None
8	65	F	OD	2+ NS	20/25	−2.00 −1.00 x 101	19	24.43	3.38	N/R	44.4	3	Divide-and-Conquer	2+	Inferior Angle	75	20/20	None
9	73	F	OD	2+ NS	20/40	+2.25 sphere	12	21.31	2.37	N/R	45.1	2	Divide-and-Conquer	Trace	Inferior Angle	9	20/30	None
10	68	F	OD	2+ NS	20/25	−3.00 −1.25 x 090	13	25.36	3.48	4.41	41.8	4	Horizontal Chop	1+	Inferior Angle	7	20/20	None
11	73	F	OD	2.5+ NS, 2+ CC	20/40	+3.00 −1.25 x 105	16	23.25	2.69	4.76	42.6	4	Horizontal Chop	2+	Inferior Angle	1	20/20	None
12	88	F	OS	3+ NS	20/70	+1.25 −0.75 x 118	14	23.10	2.55	5.08	44.6	4	Horizontal Chop	1+	Inferior Angle	15	20/20	None
13	69	F	OD	3+ NS, 2+ CC	20/70	−2.50 −7.75 x 083	18	23.35	3.58	3.76	44.0	4	Horizontal Chop	1+	Inferior Angle	7	20/20	None
14	76	M	OD	2+ NS	20/25	−2.75 −0.50 x 097	12	25.87	2.60	5.49	42.1	4	Horizontal Chop	3+	Inferior Angle	28	20/25	CME
15	84	M	OS	2+ NS, 2+ CC	20/30	−0.25 sphere	13	24.93	3.29	5.27	42.2	4	Horizontal Chop	Trace	Inferior Angle	1	20/20	None
16	60	F	OD	2+ NS, 3+ CC	20/25	−1.25 −1.25 x 077	14	23.32	3.06	4.45	44.4	4	Horizontal Chop	Trace	Inferior Angle	21	20/20	None
17	80	F	OD	3+ NS	20/40	−4.25 −2.50 x 099	13	23.60	3.11	4.80	46.5	5	Divide-and-Conquer	1+	Inferior Angle	21	20/20	None
18	73	M	OS	2+ NS	20/25	−2.25 −2.00 x 174	8	25.99	3.29	4.49	43.3	4	Horizontal Chop	1+	Inferior Angle	35	20/30	None
19	76	M	OS	2+ NS, 3+ CC	20/25	+1.50 −0.75 x 060	13	23.51	3.02	4.80	43.5	4	Horizontal Chop	1+	Inferior Angle	3	20/20	None
20	71	F	OD	4+ CC	HM	NI	15	N/R	2.56	N/R	43.2	4	Horizontal Chop	1+	Inferior Angle	1	20/15	None
21	76	M	OD	2+ NS	20/250	−3.00 −2.00 x 088	16	23.91	3.25	N/R	42.1	4	Horizontal Chop	2+	Inferior Angle	7	20/20	CME
22	78	F	OD	2+ NS, 2+ CC	20/50	+1.25 −1.50 x 096	12	23.21	2.77	5.01	43.8	4	Horizontal Chop	2+	Inferior Angle	1	20/25	None
23	77	M	OS	2+ NS	20/100	−1.75 −1.75,180	16	23.52	3.12	4.64	47.0	4	Horizontal Chop	1+	Inferior Angle	1	20/20	None
24	86	M	OD	2.5+ NS	20/40	−0.25 −0.75 x 110	13	23.83	3.44	4.99	45.1	4	Horizontal Chop	3.5+	Inferior Angle	132	20/25	None

Notes: *Patient 5 had Fuchs endothelial dystrophy with 2+ endothelial folds. Age = years; IOP = mmHg; AL = (mm); ACD = (mm); LT = (mm); Km = (D).

Abbreviations: NS, nuclear sclerotic; CC, cortical cataract; BCVA, best corrected visual acuity (Snellen); IOP, intraocular pressure; AL, axial length; ACD, anterior chamber depth; LT, lens thickness; Km, keratometry mean; CME, cystoid macular edema; NI, no improvement; N/R, not recorded.

Figure 1 Mean intraocular pressure measured pre-CE, at the time of retained lens fragment diagnosis, and post-retained lens fragment removal.

Table 2 Two-Tail t-Test Assuming Equal Variances

	Study (n = 24)			Control (n = 233)			p-value
	Mean	SD	Range	Mean	SD	Range
*Age	76	± 6.72	(60–88)	63	± 11.41	(22–86)	<0.001
IOP (mmHg)	15	± 2.59	(8–19)	14	± 2.98	(6–26)	0.2
Axial Length (mm)	23.82	± 1.11	(21.31–25.99)	23.88	± 1.28	(19.96–28.25)	0.70
*Anterior Chamber Depth (mm)	3.11	± 0.37	(2.37–3.6)	3.33	± 0.39	(2.48–4.31)	0.01
Aqueous Depth (mm)	2.58	± 0.31	(2.0–3.04)	2.74	± 0.37	(1.94–3.61)	0.06
*Lens Thickness (mm)	4.77	± 0.44	(3.76–5.49)	4.35	± 0.44	(3.23–5.34)	<0.001
Km (D)	44.01	± 1.68	(40.55–47.0)	43.72	± 3.52	(40.25–47.9)	0.69
White-to-White (mm)	12.11	± 0.46	(11.3–13.1)	12.06	± 0.44	(10.81–13.24)	0.62

Note: *p < 0.05.

Figure 2 Incidence rate of retained lens fragments following CE per year between 2003 and 2021.