A Rare Case Of Traumatic Cataract Followed By Phacogenic Uveitis And Secondary Neovascular Glaucoma

Published 2022 - 40th Congress of the ESCRS

Reference: CC02.08 | Type: Case report | DOI: 10.82333/6and-sp08

Authors: Calin Petru Tataru ¹ , Catalina Ioana Tataru ² , Laura Denisa Preoteasa ² , Paul Filip Curca* ² , Alexandra Mosu ²

¹cataract surgery department,Clinical Emergency Eye Hospital,Bucharest,Romania;cataract and refractive surgery department,Alcor Clinic,Bucharest,Romania, ²cataract surgery department,Clinical Emergency Eye Hospital,Bucharest,Romania

We present a difficult case of traumatic cataract followed by phacogenic uveitis and secondary glaucoma and describe the surgical and medical approach together with challenges faced along the way.

Clinical Emergency Eye Hospital, Department of Ophthalmology, Bucharest, Romania.

A 51-years old patient is admitted with a VA of hand-motion in the LE on account of a penetrating ocular trauma and normal RE. LE slit-lamp examination revealed sutured corneal wound with iris incarceration, keratic precipitates, unilateral total cataract with a small breach into the anterior capsule, subtle iris neovascularization, 360° posterior synechiae (seclusio pupillae) and inflammatory membrane. IOP was 35 mmHg. B-mode ultrasonography only showed inflammatory vitreous echoes. Medical treatment was started at presentation with topical NSAIDs, corticosteroids, mydriatic-cycloplegic and anti-glaucoma drops combined with systemic ocular hypotensive therapy and oral corticosteroids.

The primary surgery aimed for iris release and pupillary membrane removal using a vitreous cutter. During this procedure, iris neovessels ruptured and filled the anterior chamber (AC) with blood strings. After washing the AC, an iridectomy was made to prevent angle closure, followed by an anti-VEGF intravitreal injection. We made the decision to postpone the cataract extraction to a second act when neovascularisation is reduced. After one month, the patient returned without neovessels or AC inflammation. We made a successful, yet difficult and through a small pupil, cataract extraction. The intact posterior capsule allowed for a one-piece intraocular lens implant in-the-bag. A second anti-VEGF intravitreal injection was made. At 1-month follow-up, BCVA improved to 20/40 and IOP was 15 mmHg.

Traumatic cataract serves as a challenging task, which can result in various complications. In our case particularly, uveitis is initially a consequence of the traumatic event, which led to a small breakage of the anterior capsule. Our patient was also diagnosed with secondary neovascular glaucoma, probably due to persistent intraocular inflammation. Management of lens-induced uveitis requires careful medical treatment along with minimally invasive surgical techniques. The complexity of our case is based on the intraocular neovessels' rupture due to iris manipulation which impeded the success of the first surgery and the significant concerns during the second attempt in terms of small pupil, zonular instability and re-bleeding.