Just the other week, one of our residents presented a case on a retained lens fragment (RLF) that he had to manage at the local VA hospital. He presented his case and approach during our monthly M&M conference. He noted that his patient had a straightforward cataract and was doing well on POD#1. The patient was scheduled for follow-up in 2 weeks but presented earlier with "foggy vision."
The resident noted some sectoral cornea edema, normal IOP, mild AC inflammation, and no injection or pain (less concern for endophthalmitis). He presented the case to the attending physician who asked if he had performed a gonioscopic exam on the patient. The resident replied no and promptly performed the gonioscopy, which revealed the RLF. The patient was taken to surgery and the RLF was removed without incident.
Around the same time, I had a patient on whom I had performed an intraocular lens exchange with intrascleral haptic fixation (ISHF) earlier this year. Despite his uncomplicated case with a good postoperative result, he has some mild chronic inflammation and developed CME a few months after surgery. The iritis/CME resolved with topical treatment. There was no IOL malposition or iris chafe, which typically causes CME in ISHF.
