Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 1650
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
LETTER TO THE EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 244-245

Retained lens fragment in the anterior chamber five years after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation


1 Department of Ophthalmology, National University Hospital, Singapore
2 Department of Pathology, National University of Singapore; National University Hospital, Singapore

Date of Web Publication8-May-2012

Correspondence Address:
Manotosh Ray
Department of Ophthalmology, 1E, Kent Ridge Road, NUHS Tower Block, Level 7, Singapore - 119228

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.95891

Rights and Permissions

How to cite this article:
Ray M, Ho SW, Nga ME. Retained lens fragment in the anterior chamber five years after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation. Indian J Ophthalmol 2012;60:244-5

How to cite this URL:
Ray M, Ho SW, Nga ME. Retained lens fragment in the anterior chamber five years after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation. Indian J Ophthalmol [serial online] 2012 [cited 2019 Aug 23];60:244-5. Available from: http://www.ijo.in/text.asp?2012/60/3/244/95891

Dear Editor,

We report a case of retained lens fragment in the anterior chamber five years after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation.

A 76-year-old woman had presented with four days' history of sudden-onset redness, mild pain and blurring of vision in her left eye. Her background medical history included Type II diabetes mellitus, hypertension and hyperlipidemia. The patient had undergone an uneventful left eye phacoemulsification with posterior chamber intraocular lens (IOL) implantation in the same centre five years ago. She developed epiretinal membrane (ERM) with macular pseudo-hole in the left eye one year after cataract surgery. She also had bilateral mild non-proliferative diabetic retinopathy (NPDR) without macular edema. The best-corrected visual acuity in the left eye was 20/40 six months prior to onset of current symptoms. The presenting visual acuity was counting fingers at 2 meters. Slit-lamp examination revealed injected conjunctiva, presence of inferior wedge-shaped corneal edema with Descemet's folds extending up to the pupillary axis and a lens fragment near 6 o'clock in the inferior anterior chamber [Figure 1]. There was anterior segment inflammation with 2+ cells. The intraocular pressure was normal (11 mm of Hg). The posterior segment examination reaffirmed ERM with macular pseudo-hole and mild NPDR. The patient was not a myopic before cataract extraction in either eye. The axial length was 22.0 mm in the affected eye.
Figure 1: Lens fragment in the anterior chamber with corneal edema

Click here to view


The patient underwent surgical removal of the lens fragment five days later under topical anesthesia. The corneal edema and the anterior chamber inflammation resolved completely. The best-corrected visual acuity returned to 20/40 at one-month follow-up.

Past studies had documented retained lens fragment in the anterior chamber six to eight months after uncomplicated cataract surgery. [1],[2] Teo et al., suggested that these retained lens fragments are more likely to occur in high myopes, patients with small pupil and hard nucleus. [1] The authors postulated increased chattering of the nucleus due to high ultrasonic power as a possible mechanism. Occasionally, the lens fragment may migrate anteriorly possibly due to postural changes along with movement of the iris in changing ambient lighting. [2] Rarely, a tiny lens fragment may remain hidden in the anterior chamber angles. [3]

In our case, the patient remained asymptomatic for five years without a single episode of anterior uveitis in the past. The patient was neither myopic nor had a small pupil during the cataract surgery. She underwent routine dilated fundus examination in her every visit due to her retinal conditions when she demonstrated moderate pupillary dilation. Although she precisely denied any episode of pain, redness or discomfort in the past, it is possible to have low-grade inflammation in the anterior chamber with minimal symptoms that she may have ignored. The lens fragment was reasonably large [Figure 1] to be missed out in the previous visits if it was sequestered at an obvious position. It is possible that the fragment was trapped under one of the IOL haptics close to the equator. The lens fragment rather looked fresh with a sharp edge that was indeed unusual. Possibly a firm adhesion of the anterior capsule to the anterior surface of the IOL had provided a relative protection to the lens fragment from aqueous current. The same could explain the lack of significant inflammations. Some unknown factor may have triggered the opening of capsular adhesion from the IOL and eventual release of the lens fragment after five years.

 
  References Top

1.
Teo L, Chee SP. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Int Ophthalmol 2010;30:89-91.   Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Braude LS, Schroeder RP. Retained nuclear fragment 1 year after uncomplicated phacoemulsification cataract extraction with posterior chamber lens implant [letter]. Arch Ophthalomol 1999;117:847-8.  Back to cited text no. 2
    
3.
Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Ophthalmology 2006;113:1949-53.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed3090    
    Printed16    
    Emailed0    
    PDF Downloaded126    
    Comments [Add]    

Recommend this journal