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      A Retained Lens Fragment Induced Anterior Uveitis and Corneal Edema 15 Years after Cataract Surgery

      case-report

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          Abstract

          A 60-year-old male was referred to the ophthalmologic clinic with aggravated anterior uveitis and corneal edema despite the use of topical and systemic steroids. He had undergone cataract surgery in both eyes 15 years previous. Slit lamp examinations revealed a retained lens fragment in the inferior angle of the anterior chamber, with severe corneal edema and mild anterior uveitis. The corneal edema and uveitis subsided following surgical extraction of the lens fragment. That a retained lens fragment caused symptomatic anterior uveitis with corneal edema 15 years after an uneventful cataract surgery is unique. A retained lens fragment should be considered as one of the causes of anterior uveitis in a pseudophakic patient.

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          Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision.

          H Dick, T Kohnen, F K Jacobi … (2015)
          To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters. Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year. Collective data showed an ECL of 7.9 +/- 4.1% (mean +/- standard deviation) at 2 to 5 days postoperatively, 6.7 +/- 2.9% after 6 months, and 7.3 +/- 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST 11/2 to 21/2 min, and 9.6% with UST > 21/2 to 31/2 min; in Group B it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively. Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.
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            Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.

            John Shuler, Steven Gedde, I Hui … (2006)
            To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). Single-center, retrospective, noncomparative, consecutive case series. Sixteen patients with a diagnosis of retained nuclear fragments in the AC. Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded. Visual outcome and visual acuity at last follow-up visit. Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30. Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.
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              Retained intravitreal lens fragments after cataract surgery.

              Grant Gilliland, William L. Hutton, Dwain Fuller (1992)
              The purpose of this study is to review the possible benefits and complications of vitrectomy for retained lens fragments after cataract surgery. The authors reviewed the charts of 65 patients referred over a 12-year period for retained lens fragments after cataract surgery. Of these, 56 underwent vitrectomy and 9 were followed. Of these 56 eyes, 29 (52%) had received an intraocular lens (IOL) at the time of cataract surgery. Resulting complications from retained lens material included glaucoma (52%), corneal edema (46%), uveitis (56%), and decreased vision (100%). These sequelae responded equally to vitrectomy in eyes with or without an IOL and irrespective of type of cataract surgery (phacoemulsification or extracapsular cataract extraction). The timing of surgery did not statistically influence the final vision or the incidence of glaucoma. Removal of retained lens fragments allows rapid visual restoration, enhances resolution of uveitis, and improves control of glaucoma. Insertion of an IOL at the time of cataract surgery in the face of dislocated lens fragments is not contraindicated provided that it could be performed safely.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Ophthalmol
                Journal ID (publisher-id): KJO
                Title: Korean Journal of Ophthalmology : KJO
                Publisher: The Korean Ophthalmological Society
                ISSN (Print): 1011-8942
                ISSN (Electronic): 2092-9382
                Publication date (Print): February 2011
                Publication date (Electronic): 17 January 2011
                Volume: 25
                Issue: 1
                Pages: 60-62
                Affiliations
                [1 ]Department of Ophthalmology, Yonsei University Medical Center, Seoul, Korea.
                [2 ]Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
                Author notes
                Corresponding Author: Eun Jee Chung, MD. Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, #1232 Baekseok 1-dong, Ilsandong-gu, Goyang 410-719, Korea. Tel: 82-31-900-0590, Fax: 82-31-900-0049, eunjee95@ 123456hanmail.net
                Article
                DOI: 10.3341/kjo.2011.25.1.60
                PMC ID: 3039198
                PubMed ID: 21350698
                SO-VID: 7c632647-ebff-421e-81d3-2b6d6f1f1eee
                Copyright © © 2011 The Korean Ophthalmological Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 June 2010
                Date accepted : 14 July 2010
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: recurrent anterior uveitis,cataract,anterior chamber,lens fragment
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: recurrent anterior uveitis, cataract, anterior chamber, lens fragment

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