In this week’s issue

Journal: AJOCR

A delayed referral can turn a routine surgical complication into a vision-threatening one. Retained lens fragments after cataract surgery can provoke phacoantigenic uveitis, an inflammatory reaction to exposed lens proteins, and are typically managed with timely vitrectomy. When removal is delayed, the inflammation can become severe and extend beyond the vitreous.

A 61-year-old woman presented with severe pain and injection in the right eye two months after phacoemulsification at an outside hospital. She was unaware of any intraoperative complications, and her vitreoretinal referral was significantly delayed due to the 2024 Korean medical crisis. Visual acuity was hand motion, with intraocular pressure of 34 mmHg, a hypopyon, and a dense vitreous opacity, which was concerning for panuveitis or endophthalmitis. She underwent emergency 25-gauge pars plana vitrectomy, during which retained lens particles were found in the inferonasal periphery and removed. Intraoperative fundus examination showed granular, discontinuous precipitates along the retinal arteries. Fluorescein angiography revealed arterial beading, luminal stenosis, and peripheral non-perfusion, and OCT showed hyperreflective thickening of the arterial walls, consistent with retinal arteritis. After removal of the lens material and a course of oral corticosteroids, the inflammation resolved, and best-corrected visual acuity improved to 20/40 six months afterward.

This case highlights that prolonged lens retention can cause chronic inflammation extending to the retinal vasculature, and that early vitreretinal intervention is essential to mitigate the potential of severe vision loss.

A 35-year-old man presents to your clinic with a chief complaint of blurry vision in his right eye. He tells you that for as long as he can remember, his vision has been worse in the right eye, and he is especially bothered by the glare of lights when driving at night. His BCVA OD is 20/25.

Your slit lamp examination findings are shown below. Based on these findings, you recommend cataract surgery to the patient. However, you explain that his surgery will be complex. How might his surgery be different than a more “routine” case?

A. Cumulative dissipated energy (CDE) will be high

B. Hydrodissection should be skipped

C. Post-surgery visual acuity is limited by amblyopia

D. There is an increased risk of zonular weakness

E. Polishing the posterior lens capsule is a critical step

Click Here For Answers!