title: Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.
abstract: OBJECTIVE
  To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC).
  
  
  METHODS
  Single-center, retrospective, noncomparative, consecutive case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
authors.forename: Jennifer I
authors.initials: JI
authors.lastname: Hui
authors.forename: Jane
authors.initials: J
authors.lastname: Fishler
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
authors.forename: Magdalena F
authors.initials: MF
authors.lastname: Shuler
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Gedde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology*; D002387:Cataract Extraction / Q000379:methods*; D015715:Corneal Edema / Q000209:etiology; D005260:Female; D006068:Gonioscopy; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D007907:Lens Nucleus, Crystalline / Q000473:pathology* / Q000601:surgery; D007906:Lens Subluxation / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014785:Vision, Ocular