Spontaneous Absorption Of A Traumatic Cataract After A Non-Penetrating Ocular Trauma: A Rare Case

To describe the surgical management and unusual finding of spontaneous traumatic cataract absorption in a young patient following severe ocular sequelae from a fireworks injury.

Cornea Service, Centro de Oftalmología Barraquer, Barcelona, Spain.

A 24-year-old male presented 10 months after sustaining a non-penetrating ocular trauma in the left eye due to a fireworks explosion. Initial treatment was limited to medical management. At presentation, the patient had light perception in the affected eye. Examination revealed inferior corneal fibrosis with inactive vascularization, a dense neovascular pannus and a fibrotic inflammatory membrane with nearly 360° posterior synechiae. The pupil was non-reactive and a white cataract was observed and documented via anterior segment tomography. The surgical plan included excision of preiridial fibrosis, open-sky cataract extraction, temporary keratoprosthesis placement and penetrating keratoplasty.

The surgery was performed four months after the initial visit. During the procedure, dense nasal-inferior fibrosis was carefully dissected. Surprisingly, no cataract was found beneath the scar tissue, a finding confirmed by anterior segment tomography conducted just before the surgery, which documented the spontaneous reabsorption of the lens. The anterior hyaloid remained intact and the patient was left aphakic as there was no viable capsule for intraocular lens implantation. Subconjunctival anti-VEGF and corticosteroids were administered intraoperatively. Postoperatively, a posterior segment examination revealed Chorioretinitis Sclopetaria, significantly limiting the visual prognosis.

Spontaneous absorption of traumatic cataracts after non-penetrating trauma is extremely rare and more commonly associated with penetrating injuries. While the exact mechanism remains unclear, immune responses and osmotic factors likely contribute, especially in cases involving hypermature cataracts or compromised lens capsule integrity. In penetrating trauma with an intraocular foreign body, spontaneous emulsification of the lens cortex has been proposed as a potential mechanism. This case underscores the complexity of managing post-traumatic ocular conditions. Despite successful surgery, posterior segment pathology may significantly impact visual outcomes.