Retained lens fragments in resident-performed cataract extractions

Purpose. To investigate the incidence, management, and outcome of retained lens fragments following resident-performed cataract extraction. Methods. A retrospective review of all eyes undergoing cataract extraction by the residents of Baylor College of Medicine over a 4-year time frame (July/95-June/99). Results. A total of 3389 eyes underwent cataract extraction, and 26 patients (0.8%) required pars plana vitrectomy (PPV) for retained lens fragments. One or more vision threatening complications occurred in 19 (73%) of these patients. The most common complications were cystoid macular edema (CME) (8 eyes, 31%) and rhegmatogenous retinal detachment (RRD) formation (6 eyes, 23%). Additional surgical procedures were required for 9 (35%) eyes; the most common were repeat PPV, and placement of focal photocoagulation for diabetic macular edema (4 eyes per each procedure, 15%). Six-month follow-up was available for 16 eyes; of these, best-corrected visual acuity was 20/40 or better in 5 (31%) and 20/200 or worse in 7 (44%). The most common reasons for limited visual acuity were RRD (3 eyes, 19%) and CME (3 eyes, 19%). Conclusion. In this retrospective series, the incidence of retained lens fragments following resident-performed cataract extraction was less than 1%. Significant complications, resulting in the need for additional surgical procedures, occurred in most of these eyes, and this was associated with limited visual function at final follow-up. Retention of lens fragments following resident-performed cataract extraction remains an infrequent yet serious complication associated with a guarded visual prognosis.