Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.

OBJECTIVE: To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). DESIGN: Single-center, retrospective, noncomparative, consecutive case series. PARTICIPANTS: Sixteen patients with a diagnosis of retained nuclear fragments in the AC. METHODS: 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. MAIN OUTCOME MEASURES: Visual outcome and visual acuity at last follow-up visit. RESULTS: 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. CONCLUSIONS: 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.

Determination of the incidence and clinical characteristics of subsequent retinal tears following treatment of the acute posterior vitreous detachment-related initial retinal tears.

PURPOSE: To determine the incidence of subsequent retinal tears (SRT) in patients who were previously treated for acute posterior vitreous detachment (PVD)-related retinal tears. DESIGN: Retrospective chart review. METHODS: A retrospective chart review of 155 eyes of 137 consecutive patients treated for acute PVD-related retinal tears was performed. RESULTS: During a median follow-up of 13 months (range 3 to 157 months) after treatment, SRT developed in 19 (12.2%) of 155 treated eyes. Most of the SRT occurred during the first 6 months (12 of 19 eyes) after initial treatment. Subsequent vetinal tears developed within the first 12 months in 15 of 19 treated eyes, however only six of 15 of these eyes were symptomatic. Of those patients who developed SRT after 12 months, all had new visual symptoms. CONCLUSION: Patients who present with acute PVD-related retinal tears are at a low but significant risk for developing SRT. A significant number of patients treated for PVD-associated retinal tears present within 1 year with SRT without symptoms.