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It happens to all surgeons once in a while
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It's the day after cataract surgery, and your patient is thrilled. She is seeing well and already asking for surgery of her other eye. Your staff has measured the vision at 20/25 and the pressure at 19 mm Hg. But when you look with the slit lamp, you notice a retained lens fragment.
 A patient with a retained lens fragment who did very well after a few shots of the YAG laser and oral acetazolamide for 48 hours. |
With phacoemulsification, we're breaking the cataract up into so many small pieces that, occasionally, a small piece can be inadvertently left behind. In our case, there is a small piece of fluffy white cortex at the inferior angle. Normally, these pieces will slowly dissolve with inflammation during the postoperative period and will pose minimal difficulty. The corneal endothelium should be monitored to ensure its health during this period. And if the piece is larger or of nuclear origin, then it may be advised to go back to the operating room to aspirate out this fragment.
For small cortical pieces, the YAG laser can be used to hasten the resolution. Because the piece of cortex "melts" via inflammation, if we use the YAG laser to break it up into many smaller pieces, the surface area to volume ratio is better and it clears faster. Think of an ice cube melting vs. crushed ice. The small pieces can also be cleared through the trabecular meshwork, but they may also cause a transient rise in IOP, so that should be monitored and perhaps attenuated via medications.