Posterior Capsule Rupture In Traumatic Cataract With Intraocular Foreign Body: A Case Report

To discuss the management of traumatic cataract with intraocular foreign body (IOFB). The importance of a complete and good preoperative evaluation of cataract and IOFB conditions to prevent complications.

A 40-years-old man with his right eye was hit by a bounce while sawing wood 4 days ago. visual acuity 1/300 and TIO within normal limits. In ophthalmology examination show full thickness lacerations in the corneal with a size of 2x2 mm with seidel test (+). COA effects shallow. IOFB appears from laceration wounds to lenses. The lens appears cloudy evenly. Funduscopy cannot be assessed. From ultrasound examination, IOFB and membrane like lesion are not obtained in the posterior segment.

The patient underwent IOFB and cataract extraction surgery. During surgery, the main incision at 11 o'clock. Insert triphan blue to identify the anterior capsule tear. IOFB was successfully extracted through the main incision. IOFB is a twisted metal nail with a sharp tip. PCR occurs during IOFB extraction in main incision. Insert a dispersive visco to form a COA and hold the vitreous. Sewing wounds on the cornea. Cataract aspiration is done with irrigation/aspiration handpiece with low flow-rate and vacuum settings. PCR identification at 9-11 o’clock with visible prolapse vitreous. Perform an anterior vitrectomy with vannas. 3-piece IOL implantation has done in the sulcus. Then inject antibiotics intracameral and intrastromal.

On the first post-operative day the vision was slightly clear with visual acuity 1/60 and IOP 17 mmHg. On examination, corneal edema with 4 corneal sutures and 2 corneoscleral sutures. COA is formed, hyphema (-), hypopyon (-). The pupil is central with a diameter of 4 mm. stable lens in the sulcus. The patient performed aff suture corneosclera at 1 month post-operatively and aff suture at 2 months post-operatively. On examination 5 months post-operatively, visual acuity was 6/30 with a spherical correction of +2.00 increasing to 6/8.5 and IOP 13 mmHg. There is a leucoma in the suture mark. The lens is stable in the sulcus. Funduscopy within normal limits. There were no signs of infection in the patient.

Prior to surgery, a complete and good identification of the IOFB is mandatory. Traumatic cataracts with metal IOFB need to be X-ray or CT-scans imaging as identification to prevent complications that may occur during surgery. Adequate administration of antibiotics during surgery and after surgery is important to prevent infectious complications such as endophthalmitis. Continuous postoperative evaluation needs to be done so that complications can be treated quickly.