Panuveitis with extensive retinal arteritis after delayed referral of retained lens fragments

To report severe panuveitis with extensive retinal arteritis caused by prolonged retained lens fragments following cataract surgery, in the setting of delayed referral during the 2024 Korean medical crisis.

A 61-year-old woman presented with severe ocular pain and injection in the right eye two months after phacoemulsification cataract surgery performed at an outside hospital. The patient was unaware of any intraoperative complications, and no formal referral had been made. Vision was hand motion with elevated intraocular pressure (34 mmHg), hypopyon, and dense vitreous opacity suggesting panuveitis or endophthalmitis. Emergency 25-gauge pars plana vitrectomy was performed, during which retained lens particles were identified at the inferonasal periphery and removed using Ocutome® lensectomy. Intraoperative fundus examination revealed retinal arteries accompanied by granular, non-continuous peri-arterial precipitates. Correspondingly, fluorescein angiography demonstrated arterial beading, luminal stenosis, and peripheral non-perfusion, while optical coherence tomography confirmed hyperreflective thickening of the arterial wall consistent with arteritis. Following surgical removal of the antigenic lens material and oral corticosteroid therapy, ocular inflammation subsided, and the best-corrected visual acuity improved to 0.5 at 6-month.

Prolonged lens retention can cause panuveitis with chronic phacoantigenic inflammation extending to retinal vessels, resulting in extensive arteritis. Early vitreoretinal referral after retained lens fragments is critical, particularly during healthcare crises requiring prioritized communication to prevent vision-threatening sequelae.