Retained Lens Fragments Associated With Lens Thickness and Chamber Depth

Cataract surgery
treatment of a cataract by a surgical method
A study looks at patient age, anatomical features and surgical techniques to understand cataract surgery complications.

Risk for retained lens fragments may be higher among patients with increased lens thickness and shallow anterior chamber depth, according to results of a case series and narrative review, published in Clinical Ophthalmology.

Patients (n=24) who underwent cataract surgery with phacoemulsification and who were subsequently found to have lens fragments in the anterior chamber between 2003 and 2021 at Hoopes Vision Research Center in the United States were retrospectively reviewed. Trends in clinical outcomes were compared with a control group of patients (n=117) who underwent uncomplicated cataract surgery between 2019 and 2020.

During the study period, a total of 23,232 lens removal surgeries were performed. Retained lens fragments occurred at a rate of 0.10%. Stratified by year, the per-surgeon rate of fragmented lenses ranged between 0.00% to 0.85%. Retention of fragments was not associated with surgical technique (P =.71).

Fragment removal occurred an average of 26 (range, 1-138) days after cataract surgery. Fragments were most frequently located in the inferior angle of the anterior chamber (92%).

Fragment removal associated with a mean improvement in uncorrected distance visual acuity of 0.46 logarithm of the minimum angle of resolution and intraocular pressure was significantly decreased (11±2.75 mm Hg) compared with before cataract surgery (14±2.5 mm Hg; P <.001) or before fragment removal (19±8.2 mm Hg; P <.001).

After removal, 2 patients developed cystoid macular edema.

Compared with the control group, patients with lens fragments were older (mean, 76 vs 63 years; P <.001), had thicker lenses (mean, 4.77 vs 4.35 mm; P <.001), and had a more shallow anterior chamber (mean, 3.11 vs 3.33 mm; P =.01).

This study may have been limited by not performing routine gonioscopy after cataract removal which could have led to the under diagnosis of fragments.

The study authors concluded that older age, a thicker lens, and a shallow anterior chamber may increase risk for retained lens fragments following cataract surgery.


Moshirfar M, Lewis AL, Ellis JH, McCabe SE, Ronquillo YC, Hoopes Sr PC. Anterior chamber retained lens fragments after cataract surgery: a case series and narrative review. Clin Ophthalmol. 2021;15:2625-2633. doi:10.2147/OPTH.S314148