Five-Year-Old Sequestered Retained Lens Fragment Requiring Keratoplasty

A 77-year-old male with a history of cataract extraction and intraocular lens placement 5.5 years prior, was referred for idiopathic corneal edema of the right eye. Six months prior to initial consult with a Cornea specialist, the patient presented with acute onset cystoid macular edema (CME) and later developed anterior chamber (AC) cell. The cornea became diffusely edematous and decompensated on topical steroids and hypertonic drops. During the Descemet's membrane endothelial keratoplasty (DMEK) procedure, a sequestered retained lens fragment (RLF) migrated out of the posterior chamber and was aspirated. The remainder of the surgery and post-operative period was unremarkable. This case is the first reported in which a significantly delayed onset of inflammatory reaction from a sequestered RLF led to full corneal decompensation requiring keratoplasty. This case highlights the importance of RLF suspicion in delayed presentation, even when RLFs are not visible via slit-lamp or on gonioscopic view.