Traumatic Cataract With Rupture Of The Capsule , Rupture Of The Iris And Presence Of Vitreous Bands.

The purpose of this presentation is to explore the intricate decision-making process in treating a patient with a traumatic cataract resulting from a glass-related injury, leading to corneo-scleral perforation, lens capsule rupture, iris rupture, and vitreous bands. Specifically, the presentation will discuss the use of anterior vitrectomy to manage vitreous prolapse and pupil reconstruction to repair the anterior chamber and stabilize the eye. The goal is to provide insight into the application of these advanced techniques and their role in preserving vision and ocular function after severe trauma.

Albanian Eyes Center, Tirana, Albania

A 43-year-old male patient presented to our clinic with visual impairment following a car accident one month prior, during which he was struck by pieces of glass in his left eye. He had undergone initial surgery at two different clinics, resulting in suturing of the corneo-scleral wound. Upon examination, the best-corrected visual acuity (BCVA) was limited to "light perception." The diagnosis included sutured corneo-scleral wound, traumatic cataract with rupture of the lens capsule, iris rupture, and vitreous bands in the inferior anterior chamber.

The patient underwent a comprehensive surgical intervention, which included anterior lensectomy by anterior vitrectomy (25 gauge) through the anterior chamber, followed by implantation of a three-piece IOL (Alcon MA60AC). A pupiloplasty was performed using a modified Seipser sliding knot for iris suturing with 10.0 prolene suture, and the previously treated corneo-scleral wound was reworked.

Two months post-surgery, the patient’s BCVA is significantly improved, though the visual outcome remains difficult to fully assess due to the presence of multiple corneal sutures. This case highlights the challenges of managing complex traumatic ocular injuries and underscores the role of advanced surgical techniques in restoring ocular integrity and improving visual prognosis in cases involving multiple structural ruptures and vitreous involvement.

This case highlights the complexity of managing traumatic cataracts with corneo-scleral perforation, lens capsule rupture, iris injury, and vitreous bands, requiring a multi-step surgical approach. Interventions such as anterior vitrectomy, anterior lensectomy, pupiloplasty, and three-piece IOL implantation were essential in restoring ocular integrity and improving visual function. While the patient showed visual improvement two months post-surgery, the presence of corneal sutures made full assessment challenging. The case underscores the importance of timely and comprehensive surgical intervention in complex eye trauma and the need for careful post-operative monitoring to evaluate long-term visual recovery.