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

Majid Moshirfar,1– 3 Adam L Lewis,4 James H Ellis,5 Shannon E McCabe,1,6 Yasmyne C Ronquillo,1 Phillip C Hoopes Sr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medic...

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Autores principales:	Moshirfar M, Lewis AL, Ellis JH, McCabe SE, Ronquillo YC, Hoopes PC Sr
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	retained lens fragments phacoemulsification cataract surgery complications of cataract surgery refractory corneal edema; Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/015f820b050f4dcb9c1ba3b6b168541c
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spelling	oai:doaj.org-article:015f820b050f4dcb9c1ba3b6b168541c2021-12-02T18:01:08ZAnterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review1177-5483https://doaj.org/article/015f820b050f4dcb9c1ba3b6b168541c2021-06-01T00:00:00Zhttps://www.dovepress.com/anterior-chamber-retained-lens-fragments-after-cataract-surgery-a-case-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Majid Moshirfar,1– 3 Adam L Lewis,4 James H Ellis,5 Shannon E McCabe,1,6 Yasmyne C Ronquillo,1 Phillip C Hoopes Sr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4Kansas City University, Kansas City, MO, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarMedical Director Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comIntroduction: Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments.Methods: Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group.Results: Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years ± 6.72 (60– 80) compared to 63 ± 11.41 (22– 86) in the control group (p < 0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg ± 2.59, 19 mmHg ± 8.20, and 11 mmHg ± 2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm ± 0.37 vs 3.33 mm ± 0.39, p = 0.01) and lens thickness (4.77 mm ± 0.44 vs 4.35 mm ± 0.44, p = < 0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 ± 40 (1– 138).Conclusion: Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.Keywords: retained lens fragments, phacoemulsification, cataract surgery, complications of cataract surgery, refractory corneal edemaMoshirfar MLewis ALEllis JHMcCabe SERonquillo YCHoopes PC SrDove Medical Pressarticleretained lens fragmentsphacoemulsificationcataract surgerycomplications of cataract surgeryrefractory corneal edema;OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 2625-2633 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	retained lens fragments phacoemulsification cataract surgery complications of cataract surgery refractory corneal edema; Ophthalmology RE1-994
spellingShingle	retained lens fragments phacoemulsification cataract surgery complications of cataract surgery refractory corneal edema; Ophthalmology RE1-994 Moshirfar M Lewis AL Ellis JH McCabe SE Ronquillo YC Hoopes PC Sr Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
description	Majid Moshirfar,1– 3 Adam L Lewis,4 James H Ellis,5 Shannon E McCabe,1,6 Yasmyne C Ronquillo,1 Phillip C Hoopes Sr1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4Kansas City University, Kansas City, MO, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarMedical Director Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comIntroduction: Retained lens fragments in the anterior chamber following cataract extraction (CE) with phacoemulsification are rare but can lead to significant patient morbidity. Our study aimed to identify risk factors associated with retained lens fragments.Methods: Patients who underwent cataract surgery and subsequently identified to have retained lens fragments in the anterior segment were included. Incidence per year, patient demographics, visual acuity, ocular biometrics, surgical technique, surgeon performing CE, and outcomes were collected retrospectively and compared to a control group.Results: Twenty-four patients were identified with retained lens fragments, with an incidence of 0.10%. The mean age was 76 years ± 6.72 (60– 80) compared to 63 ± 11.41 (22– 86) in the control group (p < 0.001). Patients with UDVA 20/150 or worse experienced a greater average improvement in visual acuity compared to patients with UDVA better than 20/150 (logMAR 0.46 vs logMAR 0.05). The mean intraocular pressures before (CE), after CE but before fragment removal, and following fragment removal were 14 mmHg ± 2.59, 19 mmHg ± 8.20, and 11 mmHg ± 2.75, respectively. Twenty-two patients presented with inferiorly located fragments. Statistically significant biometrics include mean anterior chamber depth (3.1 mm ± 0.37 vs 3.33 mm ± 0.39, p = 0.01) and lens thickness (4.77 mm ± 0.44 vs 4.35 mm ± 0.44, p = < 0.001). Yearly incidence rates per surgeon ranged from 0.00% to 0.85%. In 2003 and 2004, one surgeon had significantly higher incidence rates (0.31 and 0.40%) compared to the average combined rate of all surgeons throughout the study (0.10), with p values of 0.001 and 0.003, respectively. The mean number of days between CE and fragment removal was 26 ± 40 (1– 138).Conclusion: Increased patient age, shallow anterior chamber depth, and thick lens may be risk factors for retained lens fragments. There may be additional surgeon-specific risk factors. Phacoemulsification technique (Divide-and-Conquer versus Horizontal Chop) showed no significant difference.Keywords: retained lens fragments, phacoemulsification, cataract surgery, complications of cataract surgery, refractory corneal edema
format	article
author	Moshirfar M Lewis AL Ellis JH McCabe SE Ronquillo YC Hoopes PC Sr
author_facet	Moshirfar M Lewis AL Ellis JH McCabe SE Ronquillo YC Hoopes PC Sr
author_sort	Moshirfar M
title	Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
title_short	Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
title_full	Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
title_fullStr	Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
title_full_unstemmed	Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review
title_sort	anterior chamber retained lens fragments after cataract surgery: a case series and narrative review
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/015f820b050f4dcb9c1ba3b6b168541c
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Anterior Chamber Retained Lens Fragments After Cataract Surgery: A Case Series and Narrative Review

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