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ALLOFLO AFTER TRABECULAR MICROBYPASS STENTS Lorraine M. Provencher, MD   ALLOFLO 2-1-1 (4X SPACERS) Billy Pan, MD   CANALOPLASTY WITH ITRACK ADVANCE IN AN EYE WITH TWO PRIOR ISTENT IMPLANTS: GREEN ILUMIN NAVIGATION Mahmoud Khaimi, MD   TRAUMATIC ANGLE-RECESSION GLAUCOMA (TRIPLE PROCEDURE) Enver Mirza, MD  

Left Behind

A rare complication of cataract surgery can cause a range of visual problems.

Kianna Swanson, OD, and Jacob Lang, OD, FAAO

Modern Optometry

Cataract surgery is one of the most frequently performed procedures worldwide with generally high success rates. Despite its routine nature and various technological advances, a range of ocular complications may still arise. One uncommon yet clinically significant complication is the retention of lens fragments. A REFRESHER ON RETAINED LENS FRAGMENTS The human crystalline lens consists of an anterior and posterior capsule, cortex, and central nucleus. Following phacoemulsification, an ultrasonic disruption, and removal of the natural lens, retained lens fragments are reported to occur in approximately 0.1% of cases.1 These fragments may consist of cortical and/or nuclear material and can lead to a spectrum of complications, including decreased vision, corneal edema, anterior chamber inflammation, macular edema, and/or retinal detachment. Retained lens fragments may be found in the anterior chamber, posterior chamber, vitreous cavity, or capsular bag. Nuclear fragments are yellow in color with sharp edges, whereas cortical fragments appear white and fluffy. Although most retained lens fragments are seen in the early postoperative days, in some cases, it may be decades before they are identified or pose a threat to the patient’s ocular health.2 WHAT TO DO ABOUT RETAINED LENS FRAGMENTS Early recognition, material identification, and appropriate management are critical to ensure positive patient outcomes. Most retained lens fragments can be easily seen during the slit-lamp examination (Figure); however, gonioscopy and B-scan ultrasonography may allow better visualization and localization. Management typically involves surgical removal of the fragments, although cortical lens fragments may dissolve spontaneously over time.

How Ophthalmology Strategics are Rewriting the Playbook

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