Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body

Spontaneous resolution of a unilateral cataract in an adult: A case report

RATIONALE

Cataracts are a disease that is usually caused by aging and involve the irreversible degeneration of the lens material. On the other hand, transient cataracts have also been reported, mainly due to systemic hyperglycemia, which often occurs bilaterally. However, reports of the spontaneous regression of unilaterally occurring cataracts in patients with normal blood glucose levels are rare. Here, we report a rare case of spontaneous regression of unilateral posterior subcapsular cataracts in an adult with normal blood glucose levels.

PATIENT CONCERNS

A 42-year-old woman presented with distorted vision in her right eye. The patient was taking medication for diabetes, and her blood sugar level was well-controlled.

DIAGNOSIS

Upon examination, her uncorrected visual acuity and best-corrected visual acuity were 20/70 in her right eye. Slit lamp microscopy revealed fine, feathery, and streak-like posterior subcapsular opacities. Color fundus photography revealed a star-shaped shadow due to the cataract, and no diabetic retinopathy was observed. Her two hour postprandial glucose level was 115 mg/dL. The patient was diagnosed with posterior subcapsular cataracts, and cataract surgery was planned. The patient was scheduled to visit the clinic again after seven days.

INTERVENTIONS

Close observation for one week without any intervention.

OUTCOMES

After one week, most of the posterior subcapsular opacities disappeared, and the uncorrected visual acuity and best-corrected visual acuity in the right eye improved to 20/40 and 20/30, respectively.

LESSONS

This case report demonstrates that unilateral posterior subcapsular cataracts may spontaneously regress in patients with normal blood glucose levels. Therefore, it is important to check whether cataracts improve spontaneously through short-term close follow-up before planning cataract surgery to avoid unnecessary surgery.

Spontaneous resolution of a traumatic cataract in a patient with an open-globe ocular injury: a case report

Background

We report a case of spontaneous resolution of a traumatic cataract in a patient with an open-globe ocular injury. This case highlights the importance of conservative management in these types of cases, as excellent visual outcome is possible without invasive surgical intervention.

Case presentation

A 13-year-old boy presented with a corneal laceration in the left eye caused by a neuter pen. He underwent emergency repair of the corneal laceration under general anesthesia, and at 3 days post-op, a dense posterior cortical cataract was observed. Based on the patient’s age and normal visual development, in addition to preserving accommodative potential, the patient received conservative management and follow-up. Interestingly, the cataract spontaneously resolved over the following 9 months and the corrected distance visual acuity in the injured eye was restored from finger counting at 50 cm, to 20/25 + 3.

Conclusions

To optimize treatment in pediatric traumatic cataract, several critical factors such as age, visual development and the preservation of accommodative potential, need to be comprehensively considered. Conservative management with lens preservation is important to consider in young, traumatic cataract patients where invasive surgical intervention may not be required.

Spontaneous Resolution of a Rapidly Formed Dense Cataract Following Nd: YAG Laser Peripheral Iridotomy in a Case of Pigmentary Glaucoma

A 54-year-old man was referred for a senior opinion. His vision had acutely dropped in his right eye from 6/6 to hand movements following Nd:YAG laser peripheral iridotomy for treatment of pigmentary glaucoma. A dense rosette posterior subcapsular cataract had formed in his right eye rapidly after surgery. Within 4 weeks the cataract resolved spontaneously and his vision returned to 6/6. It is hypothesized that a dual mechanism caused the rapidly formed cataract. Shockwaves stemming from Nd:YAG laser resulted in a reversible misalignment of the lenticular fibers, and localized direct damage to capsule caused osmotic imbalance and fluid collection between lamellae. Restoration of the osmotic balance, repair, and formation of lens fibers and clearing of vacuoles led to the resolution of the cataract. The proximity of the concave iris to the lens equator in pigmentary glaucoma was a predisposing factor. This highlights the importance of exercising great caution in using laser peripheral iridotomy in cases of pigmentary glaucoma, particularly if a higher laser power is used and considering initial conservative management of this complication.

Visual Outcomes and Prognostic Factors of Intralenticular Foreign Bodies in a Tertiary Hospital in North China

Purpose

The aim of this study is to describe the epidemiological and visual outcomes and to identify the main prognostic factors of intralenticular foreign body (ILFB) injuries.

Methods

We performed a retrospective review of 21 patients (21 eyes) referred to Hebei Eye Hospital in North China from January 2012 to December 2017, who underwent surgical removal of ILFBs and associated ocular trauma repairs. Data regarding the patient demographics, cause of the injury, nature of the ILFB, clinical features, time interval between the injury and the ILFB removal, time interval between the presentation and the surgery, and the initial and final best-corrected visual acuities (BCVAs) were analyzed, and the main prognostic factors were identified.

Results

Male adults were most affected by ILFBs (90.5%). The mean age of the patients was 41.5 years (median: 46 years, range: 21 to 60 years). None of the patients were wearing goggles at the time of the injury. The most common ILFB cause was hammering the metal (57.1%), and most of the ILFBs were metallic (71.4%). After medical treatment, the final BCVA was improved significantly (Z = 2.49, P=0.015). There was a significant association between the ILFBs with posterior segment injuries and the final BCVA (χ² = 10.03, P=0.01). Those factors showing no statistical association with the final BCVA included the age (χ² = 0.36, P=1.0), gender (χ² = 0.52, P=1.0), nature of the ILFB (χ² = 1.11, P=0.54), entrance wound location (χ² = 2.85, P=0.25), and time interval between the injury and the ILFB removal (χ² = 1.87, P=0.23).

Conclusion

This is the first local study to explore the epidemiology of ILFB injuries and to identify the main prognostic factors. There was a significant association between the ILFBs with posterior segment injuries and the final BCVA. Improved public awareness and strengthened education regarding safety are the key approaches to reduce the incidence of eye injuries.

Multimodal imaging in an idiopathic spontaneously absorbed cataractous lens: A rare case report

PURPOSE

To report an unusual and rare case of idiopathic spontaneous absorption of the cataractous lens and its multimodal imaging features.

METHODS

A 56-year-old female presented with a complaint of diminution of vision in both eyes (OU). Slit lamp examination of the right eye (OD) revealed Morgagnian cataract with a normal anterior segment. Slit lamp examination of the left eye (OS) revealed absorbed cataractous lens with intact lens capsule with clear visual axis. Fundus examination OS was unremarkable. No history of trauma, past ocular surgery or any ocular or systemic disease. Ultrasonography B-scan OU was unremarkable. Her blood examination was normal. Anterior segment optical coherence tomography showed increased anterior chamber depth OS. It also showed Morgagnian cataractous lens with nucleus in the bag OD and absorbed cataractous lens with thin adhered capsular bag OS. Scheimpflug imaging also showed decreased densitometry OS. She underwent successful phacoemulsification in OD with in-the-bag placement of intraocular lens. For OS with absorbed lens, she underwent phacoemulsification with anterior circular curvilinear capsulorhexis using a capsulotomy forceps. The cortical matter in the bag area was aspirated with implantation of intraocular lens in the ciliary sulcus over the intact capsule rim.

RESULTS

The patient underwent phacoemulsification with anterior continuous curvilinear capsulorhexis with intraocular lens placement in the ciliary sulcus OS.

CONCLUSIONS

This case is first of its kind in the literature. The role of ultrasound B-scan, anterior segment optical coherence tomography, and Scheimpflug imaging in the preoperative evaluation of capsulolenticular status and subsequent successful management is discussed.

Minimal surgery achieved good visual acuity in selected patients with magnetic intravitreal foreign body and traumatic cataract

BACKGROUND

To explore minimal surgery in selected patients with intravitreal foreign body (IVFD) and traumatic cataract.

METHODS

Twelve eyes of 12 patients with small ferrous IVFD and traumatic cataract without endophthalmitis, retinal injury and secondary glaucoma, between September 2015 and March 2017 were retrospectively analyzed. Primary removal of IVFD was performed by external magnetic extraction through the pars plana incision. Secondary removal of traumatic cataract by phacoemulsification and intraocular lens (IOL) implantation with or without anterior vitrectomy were performed. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months and 12 months after surgery.

RESULTS

All patients were male with a mean age of 32 years old. All IVFDs were successfully removed without retinal injury. Two to 6 months later, the traumatic cataract was successfully removed by phacoemulsification combined with IOL implantation in the capsule bag in 10 patients. Anterior vitrectomy was implied in 2 patients with large posterior capsule rupture, and the IOLs were placed in the ciliary sulcus. Best-corrected visual acuity ranged from hand movement to 20/100 before surgery and improved ranging from 20/32 to 20/20 at the final follow-up. The IOLs were well centered. Complications such as secondary glaucoma, endophthalmitis and retinal detachment were not found.

CONCLUSIONS

Primary removal of small ferrous IVFD by external magnetic extraction followed by secondary cataract removal and IOL implantation is an appropriate choice. Minimal surgery may obtain good visual outcome without complications in selected patients.

Intralenticular foreign body: A case report and literature review

day, a zonal cortical cataract and posterior subcapsular cataract formed rapidly. Left-eye bare vision dramatically decreased from 20/100 to counting fingers. One month later, the patient received elective extracapsular cataract extraction. A fine metal thread was completely embedded in the lens; the lens and FB were removed together during the operation. The posterior capsule was not injured; an intraocular lens was implanted in the capsular bag. Two months postoperatively, left-eye vision had returned to 20/25. No adverse events were noted during the follow-up period. In addition to the case report, some 28 previously reported cases of intralenticular FB are reviewed here. Patient demographics, time and course of management, and visual outcome are all summarized and compared.

Cataract surgery in the setting of trauma

PURPOSE

To review the changes in the surgical techniques used for cataract removal in the setting of trauma and their postoperative outcome.

RECENT FINDINGS

Primary cataract removal with intraocular lens (IOL) implantation is the commonly followed procedure for penetrating injuries with cataract. IOL implantation has evolved through various techniques namely 'in the bag', 'in the sulcus', epilenticular implantation, anterior chamber IOL, scleral fixated IOL and recently glued IOL.

SUMMARY

Certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and IOL implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording timelier visual rehabilitation. Secondary lens removal may also be indicated in cases of severe corneal injury and marked edema, which may interfere with intraocular visualization.