OBJECTIVE To review the clinical features, treatments, and outcomes of patients with retained lens fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. METHODS Retrospective, interventional case series. METHODS setting: Duke University Eye Center. METHODS Fifty-four eyes of 54 patients with a diagnosis of retained lens fragment in the anterior chamber following otherwise uncomplicated phacoemulsification cataract surgery. Patient demographics, clinical examination findings, ocular biometry measurements, treatment received, and pre- and post-lens fragment removal visual acuity were recorded. METHODS Corneal edema, time to surgical extraction of lens fragment, and visual acuity. RESULTS All lens fragments were located in the inferior angle or the inferior anterior chamber, with 13% of cases requiring gonioscopy for diagnosis. Fifty-six percent of eyes had associated corneal edema, most often located inferiorly. Forty-four percent of patients were initially managed medically, but in all 54 cases the lens fragment was eventually removed surgically. The mean time to removal of the lens fragment from the date of cataract surgery was 70 days (range 1 day-30 months). Five patients had corneal edema that did not resolve following fragment extraction and 3 eventually received an endothelial keratoplasty. Best-corrected visual acuity improved from an average of 20/51 before lens fragment removal to 20/28 after surgical extraction (P < .00001). CONCLUSIONS Corneal edema is common in the setting of retained lens fragments and can evolve to corneal decompensation requiring transplantation. Inferior corneal edema, in particular, should alert the practitioner to possible retained lens fragment. Surgical removal of retained lens fragments should be considered at the time of diagnosis.