MANAGEMENT OF A TRAUMATIC CATARACT

To provide key tips in the surgical management of traumatic cataracts through a case study. A 53-year-old man suffered penetrating trauma to his left eye from broken glass. His corneal laceration was sutured under general anaesthesia at presentation. Four weeks later, he was noted to have a ruptured anterior capsule and a traumatic cataract. He underwent subsequent left phacoemulsification, followed by sulcus IOL implantation.

Department of Ophthalmology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom

Key surgical techniques utilised in this case of traumatic cataract include:

• Making only paracenteses initially to maintain chamber stability while liquefied lens matter is aspirated to improve visibility.
• Using Vision blue to enhance the visualisation of the anterior capsule.
• Using viscoelastic to gently release synechiae.
• The use of iris hooks to retract the iris further and optimise the view of any capsule defect
• Utilising 23G VR scissors to instigate a new capsulorhexis flap when the anterior capsule is breached.
• Little manoeuvre can be used to complete the capsulorhexis when approaching an area of capsular damage.
• Considering MST capsular hooks and capsular tension rings.
• To avoid excessive zonular force following trauma, viscoelastic can be used to encourage the lens out of the capsular bag into the anterior chamber.
• In soft lenses consider an early switch to bimanual I/A to safely aspirate the lens followed by gentle bimanual aspiration of the residual cortex.
• If the view is poor, removing the corneal epithelium can be considered for improved visibility.
• Leaving the patient aphakic, and planning a secondary lens implant once any corneal sutures are removed, can allow for more accurate biometry and lens choice.
• If considering a primary lens implant, consider using standard K readings and using axial length from the other eye.
• Calculating the lens power for intracapsular and 3-piece sulcus IOL before starting is important.

Careful surgical planning in this case, utilising the tips outlined above, has allowed this patient to achieve a stable post-operative unaided vision of 6/9.

Complex traumatic cataracts can be managed safely and efficiently by adopting key measures and principles, which are important to consider in training.