Pancake Surgical Correction In Ocular Trauma: Combined Sulcus Pinhole Lens + Iol Implantation For Resolving Residual Astigmatism And Photosensitivity

To present the challenging cases of a 10 year-old pediatric patient, which underwent previous Cionni CTR scleral fixation + toric IOL implantation for traumatic cataract (penetrative ocular trauma) and returned after suffering a recent blunt trauma with decreased visual acuity and photosensitivity and of a 38 year-old male with a large corneal scar and traumatic cataract. In the first case YAG capsulotomy was performed followed by pinhole lens implantation to resolve residual astigmatism and photosensitivity. Intraoperatively the toric IOL was realigned with the required axis. Postoperative UCVA increased to 0.3. In the second case the pinhole lens resolved irregular astigmatism.

Department of Ophthalmology, Clinical Hospital for Ophthalmological Emergencies Bucharest, Romania. “Carol Davila” University of Medicine and Pharmacy Bucharest

A 10 year-old pediatric patient presented with decreased visual acuity and photosensitivity after suffering a recent blunt ocular trauma. The patient underwent previous surgery in our department for traumatic cataract due to penetrative ocular trauma; treated by cataract extraction and inserting a Cionni modified capsular tension ring (mCTR) with scleral fixation with prolene suture, and a toric intraocular lens (IOL) to compensate for corneal scar astigmatism. Uncorrected VA was counting fingers at 2m. Clinical examination revealed inferior corneal leucoma, rotation of the toric IOL, integrity of Cionni-scleral suture, posterior capsule opacification. We decided to perform a central YAG capsulotomy and to implant one week later a pinhole IOL to resolve residual astigmatism and photosensitivity. UCVA improved to 0.15 decimal after capsulotomy. Surgery was planned and performed. Under viscoelastic the toric IOL was mobilized and realigned on the axis, aided by preoperative horizontal and intraoperative axis scleral markings. Integrity of the CTR-IOL complex and CTR suture was thoroughly checked. The main paracentesis was enlargened to 2.7mm and the pinhole IOL was introduced in the sulcus using a cartridge injector. Due to the preexisting postraumatic iris defect a peripheral iridectomy was unnecessary. Postoperative UCVA increased to 0.3. In the second case traumatic cataract surgery included pinhole lens implantation in the sulcus for astigmatism correction; final UCVA 0.6

Managing penetrative trauma ocular injury in patients proves challenging due to post traumatic zonular dehiscence and traumatic cataract, iris defects inducing photosensitivity, irregular corneal scar astigmatism and the possibility of resultant amblyopia. In our case the previous implantation of a scleral-fixated Cionni mCTR using prolene suture and toric monofocal IOL resisted the blunt trauma, suffering only IOL rotation. After perfoming capsulotomy for capsule opacification, the toric IOL was realigned and restant astigmatism and photosensitivity resolved using a pinhole IOL implanted in the sulcus. In the second case irregular astigmatism was compensated by pinhole lens implantation. Vision improved with the complex procedures.