We read with interest the article in the December 2015 issue of the Journal by Zavodni and associates on “Clinical features and outcomes of retained lens fragments in the anterior chamber after phacoemulsification.” In 1994, we presented a case of a retained nuclear fragment in the anterior chamber at the Castroviejo society meeting and this case report was subsequently published in Cornea .

The patient presented with early postoperative persistent ocular irritation. Localized inferior corneal edema was noted. Gonioscopy showed a nuclear fragment lodged in the anterior chamber angle. A course of topical steroid therapy did not ameliorate his symptoms and there was progression of the corneal edema. Subsequent surgical removal resulted in resolution of the patient’s symptoms and reversal of the corneal edema. At that time, a literature search for this entity failed to reveal any similar reports. Dr P. Laibson had reported a series with inert small glass particles lodged in the inferior chamber angle causing a similar presentation with ocular irritation and progressive corneal edema.

Laibson’s cases required surgical removal. These cases with inert particles seem contrary to the possible toxic etiology mentioned by Zavodni and associates. The occurrence of retained nuclear fragments seems unique to phacoemulsification, with the ultrasonic force causing the nuclear fragment to be impaled in the anterior chamber angle. To our knowledge, no cases have been reported without phacoemulsification use for cataract surgery. A likely mechanism may be repeated abrasion of the corneal endothelium with normal iris movements. As with the report of Hui and associates, early surgical removal is the preferred treatment. It would be interesting to have localized endothelial measurements of these patients while the fragment is in place and after removal. We commend Zavodni and associates for their larger case series reviewing this treatable complication of phacoemulsification.