It’s tempting when you’re a beginning surgeon to just leave some residual cortex in the capsular bag but then the next morning it will swell up and end up blocking the vision and causing complications. The retained cortical material may trigger inflammation, as it acts as a foreign body and stimulates an immune response. This can present as anterior chamber reaction, increased intraocular pressure, or even cystoid macular edema in more severe cases. The material can also serve as a nidus for posterior capsular opacification (PCO), where residual lens epithelial cells proliferate and migrate, leading to visual decline over time. In some patients, especially those with narrow angles, cortical remnants in the sulcus or angle can cause secondary glaucoma. If significant, residual cortex may require surgical removal through irrigation and aspiration. However, small, quiet remnants can sometimes be monitored if the eye remains stable and inflammation-free. Careful cortical cleanup during surgery, especially under the anterior capsule and near the equator, is essential to reduce these risks and ensure optimal visual outcomes.
