Cataract And Anterior Capsular Rupture Caused By Metallic Foreign Bodies: A Report Of Two Cases And Management Approaches

Traumatic cataracts often occur after ocular injuries, presenting diverse challenges depending on the extent of damage and patient condition. This study examines two cases of traumatic cataract caused by metallic foreign body penetration, both resulting in anterior capsular rupture. The first case required staged interventions, including cataract removal and delayed intraocular lens implantation. The second case, with a stable peripheral cataract, was managed conservatively. These cases emphasize tailored treatment plans for achieving optimal outcomes in traumatic cataract management.

Two patients with traumatic cataracts caused by metallic foreign body injuries were treated with tailored therapeutic approaches. Both patients underwent detailed clinical evaluations, including slit-lamp examination, anterior segment OCT, wide-field photography, macular OCT, and B-scan. To confirm the presence of intraocular foreign bodies, non-enhanced Orbit CT scans were also performed. Treatment decisions were based on the severity of the injury and the individual patient’s condition.

Case 1 involved a 60-year-old male who presented after self-removal of a metallic foreign body (1 mm × 1 cm). He had a sealed full-thickness perforation at the 3 o'clock position with a negative Seidel test. Visual acuity (VA) was HM, and IOP was 55 mmHg. Medical management was initiated with antibiotics, topical steroids, and IOP-lowering agents. Cataract surgery was performed 8 days later. Intraocular lens implantation was deferred due to anterior capsule rupture. 

Case 2 involved a 34-year-old female who presented with a metallic foreign body embedded at the 3 o'clock cornea. Orbit CT confirmed the foreign body behind the posterior lens capsule. Foreign body removal was performed with forceps, and no corneal suturing was required.

In Case 1, IOP was reduced to 8 mmHg after 4 days of medical management, and corneal edema improved. Cataract surgery was successfully performed. Due to the anterior capsule rupture caused by the trauma, secondary IOL scleral fixation was done 3 weeks later. After 1 month, best corrected visual acuity (BCVA) was 0.9, corneal clarity was maintained, and there was no anterior chamber inflammation, requiring no further medication.

In Case 2, the foreign body was successfully removed, and the anterior chamber remained deep, so no sutures were necessary. After 1 month, VA improved to 0.6. The patient reported no significant visual discomfort and remains stable, with no anterior chamber inflammation, under observation without cataract surgery.

Traumatic cataracts require individualized management based on the severity of the injury. In Case 1, IOP and corneal edema were controlled, followed by cataract surgery and secondary IOL scleral fixation due to anterior capsule rupture. This case highlights the need for alternative strategies like scleral fixation when capsular bag implantation is not possible. In Case 2, conservative management was effective, with stable condition and no discomfort, emphasizing observation for cases with minimal visual compromise. Both cases demonstrate that early intervention and personalized treatment can achieve favorable outcomes, whether surgical or conservative.