Incidence and Outcomes of Dropped Nucleus After Phacoemulsification Cataract Surgery Between 2020 and 2024

Background: This study evaluates the incidence and outcomes of patients with dropped nucleus/nuclear fragment during phacoemulsification surgery; Methods: Retrospective review of continuous cases with dropped nucleus/nuclear fragment during phacoemulsification cataract surgery from January 2020 to December 2024. Demographic and perioperative data were collected and analysed. A good visual outcome was defined as a postoperative best-distance visual acuity of ≥6/12; Results: A total of 91,883 cases of planned phacoemulsification cataract surgery were identified, of which 175 (0.19%) were complicated by a dropped nucleus/lens fragment. Mean age was 71 years and median number of days from primary procedure to secondary fragmatome was 5 days. Good visual outcomes were achieved in 127 cases (73%). Median final intraocular pressure was 13 mmHg. Most patients required two (63%) or three (29%) operations in total and none developed endophthalmitis. Hypermature cataracts were present in 70 cases (40%) and were significantly associated with poor visual outcomes (p = 0.003). Surgeon grade and other pre-existing ocular co-pathologies known to increase posterior capsular rupture risk were not significantly associated with poor visual outcomes; Conclusions: Overall incidence and outcomes of cases complicated with dropped nucleus/fragment were favourable despite the presence of pre-existing risk factors. Emergent management is paramount to ensure good outcomes in patients.