Delayed presentation of retained nuclear fragment following phacoemulsification cataract extraction

An 87-year-old woman presented 11 months after routine phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her left eye complaining of the abrupt onset of redness and decreased vision in that eye. Examination revealed a mild anterior chamber reaction and significant corneal edema. The eye was minimally responsive to topical steroid therapy, and initial serial slitlamp examinations with gonioscopy were unrevealing. After multiple head-positioning maneuvers were performed, a retained nuclear fragment was uncovered. The nuclear fragment was aspirated and liquefied by the phacoemulsification device in the anterior chamber. A retained nuclear fragment with an intact posterior capsule is a recognized cause of inflammation in the immediate postoperative presentation. Delayed presentation of symptoms is rare and presumably secondary to sequestration of the fragment behind the iris. We present a case and a review of the literature regarding sequestered retained nuclear fragments following what is initially thought to be uneventful cataract extraction. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.