Visual results, prognostic indicators, and posterior segment findings following surgery for cataract/lens subluxation-dislocation secondary to ocular contusion injuries

Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy

AIM

The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs).

METHODS

Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1.

RESULTS

The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1.

CONCLUSION

RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.

Visual Outcome of Traumatic Cataract at a Tertiary Eye Care Centre in North India: A Prospective Study

INTRODUCTION

One of the most common presentations of blunt and penetrating ocular trauma is traumatic cataract. It remains a significant cause of visual impairment and physical disability among adults and children. It is associated with various ocular injuries.

AIM

To evaluate the associated ocular injuries and final outcome of patients with traumatic cataract along with their demographic features and modes of trauma.

MATERIALS AND METHODS

A prospective study done in Department of Ophthalmology in M.L.B. Medical college, Jhansi from February 2010 to July 2011. A total of 48 patients diagnosed as a case of traumatic cataract were subjected to a detailed history, systemic and local examination with relevant investigations. Medical or surgical managements were done accordingly. Patients were subsequently followed-up and visual acuity was recorded. Appropriate statistical tests were applied.

RESULTS

A 54.2% patients sustained penetrating trauma while 45.8% got blunt injury. Out of total, 79% patients were males while 50% were less than 15 years of age. Causative agents were stone, wood items, stick, metal objects etc. Among blunt trauma cases, 64% of the patients had visual acuity <6/60 while among penetrating trauma cases nobody had acuity >6/18. Anterior segment was more involved as compared to posterior segment. A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of >6/18.

CONCLUSION

This study provides recent data of patients hospitalized after ocular trauma and diagnosed as a case of traumatic cataract. Traumatic cataract occurs mostly in younger males. Surgical intervention is necessary to improve visual outcome. Good visual outcome was obtained in nearly half of the patients. Traumatic cataract patients can have good visual outcome depending upon proper management.

Sutured posterior chamber intraocular lenses for traumatic cataract in Africa

PURPOSE

To determine the outcomes of sutured scleral fixation of posterior chamber intraocular lenses (PC IOLs) after trauma in an African population.

SETTING

State hospital and affiliated district hospital, Cape Town, South Africa.

DESIGN

Case series.

METHODS

A retrospective review was performed of the medical records of patients in whom a sutured PC IOL had been implanted for traumatic aphakia in the preceding 5 years.

RESULTS

Eighty-five percent of the 59 patients had a significant improvement in uncorrected distance visual acuity (UDVA) at the final visit. Two-thirds of patients achieved an UDVA of 6/18 or better. Those not improving had severe preexisting macular or corneal pathology. A significant number of patients (28%) with angle recession developed ocular hypertension during the postoperative period.

CONCLUSION

After careful preoperative selection, sutured PC IOLs were effective in the visual rehabilitation of eyes with traumatic subluxated cataract in which the capsular bag could not be retained.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Subluxed traumatic cataract: optical coherence tomography findings and clinical management

This case report describes the optical coherence tomography (OCT) findings and clinical management of a patient with traumatic subluxed cataract. The patient presented with a traumatic subluxed cataract and vitreous prolapse into the anterior chamber. The anterior segment OCT showed vacuoles in the anterior subcapsular regions of the crystalline lens. The patient was treated with pars plana lensectomy, vitrectomy, and placement of an anterior chamber intraocular lens. The patient’s best corrected visual acuity improved from hand motion at presentation to 20/25 during 3 years of follow-up. Anterior segment OCT demonstrates that the clinically visible vacuoles in traumatic cataract are located in the anterior subcapsular part of the lens. This is the first report in the literature using anterior segment OCT to visualize the subcapsular vacuolar changes in a traumatic cataract.

[Most severe consequences of eye contusion injuries--surgical treatment]

INTRODUCTION

One third of all eye injuries are contusion injuries. The most common causes of contusion eye injuries are squash ball, fist fights, sports, and work with blunt objects.

OBJECTIVE

The objective of our study was to analyze the surgical treatment methods and materials for managing the most severe consequences of eye contusion injuries.

METHOD

A large number of complications of contusion eye injuries were treated at Department for Vitreoretinal Surgery of the Eye Clinic, Military Medical Academy, Belgrade. This paper analyzed two periods, from 1991-1999, and 2000-2004. During these periods, 461 patients with contusion eye injuries were surgically treated. Pars plana vitrectomy and phacoemulsification with PCL implantation were the most commonly performed operations.

RESULTS

During the analyzed period, a total of 334 pars plana vitrectomies, 253 combined operations (PHACO+ VPP) and 214 operations with PCL implantation (PHACO+VPP+PCL) were performed. Scleral fixation was carried out in 14 patients. After pars plana vitrectomy, some form of extended tamponade of vitreal space, in relation to degree of injury and complications, was performed in 194 cases.

CONCLUSION

Eye traumatism is still one of the leading causes of vision loss (from the earliest ages) in our region. Preventive measures that could lead to decrease of eye injuries should be fully supported, not only through expert meetings and publications, but via media as well.

COMBINED PARS PLANA PHACOFRAGMENTATION, VITRECTOMY, AND ARTISAN LENS IMPLANTATION FOR TRAUMATIC SUBLUXATED CATARACTS

PURPOSE

To report on the outcome of combined pars plana phacofragmentation, vitrectomy, and Artisan lens implantation in the management of subluxated cataracts.

METHODS

This prospective, interventional, nonrandomized case series included nine eyes of seven consecutive adult patients with traumatic lens subluxation. Pre- and postoperative data (complete manifest refraction, best spectacle-corrected visual acuity, slit-lamp examination findings, intraocular pressure, fundus status, numerical density of endothelial cells, corneal thickness, and complications) were collected prospectively for all patients.

RESULTS

After a median postoperative follow-up of 12 months (range, 8-18 months), a mean spherical equivalent of -0.50 +/- 0.87 diopter (range, +1 to -1.50 diopter) was achieved. The mean logarithm of the minimum angle of resolution visual acuity improved from 1 (preoperatively) to 0.1 (postoperatively) (P = 0.007, Wilcoxon test). Median endothelial cell losses of 15 +/- 8% (P = 0.008) and 14 +/- 16% (P = 0.011) were registered at follow-ups of 1 month and 12 months, respectively. Postoperative complications included chronic intraocular inflammation and superior corectopia.

CONCLUSIONS

Our procedure appears to be a safe, accurate, stable, and efficacious option for the management of traumatic subluxated cataracts in adults. However, longer-term data are needed to evaluate the corneal endothelium.

Surgery of eye injuries in an eight-year period

Background. Eye injuries constitute a leading problem in eye surgery worldwide, as well as at our department. Their treatment is very complex, and requires a wide surgical knowledge and surgical skills supported by the material and the equipment. Aim. To analyze the results of vitreoretinal surgery on 647 patients with severe penetrating eye injuries in the period from 1991 to 1998. Methods. The study included a retrospective analysis of the treatment of 647 injuries, out of which 500 were penetrating, and 147 were severe contusion injuries. Attention was payed to the penetrating injuries with intraocular foreign body (IOFB), to the number of the performed pars plana vitrectomies (VPP), to the number of the extirpated foreign bodies, as well as to the number of the conventional retinal ablation surgeries. Also significant proved the consequences of contusion injuries, and the method of their complete surgical management - the surgery combined with the implantation of intraocular lens, as well as their functional results. Results. Inside the said period, 558 VPPs were performed, 60 conventional retinal ablation surgeries, and 29 combined anterior/posterior segment surgeries. VPP was applied in 286 (51.3%) of the cases with penetrating injuries with IOFB, and in 58 (10.4%) of the cases with contusion injuries. VPP in one eye was applied in 464 (83%) of the cases, in both eyes in 65 (11.8%) of the cases, and in a single eye in 29 (5.2%) of the cases. Following VPP, silicone oil tamponade was done in 352 (63%) of the cases, air tamponade in 123 (22%) of the cases, and Ringer-BSS tamponade in 83 (15%) of the cases. Laser photocoagulation (LFC) was performed in 484 (87%) of the cases, cryocoagulation in 45 (8%), while neither of them was done in 29 (5%) of the cases. In all of the cases of the conventional retinal ablation (n = 60), a placement of a serclage was applied and exocryocoagulation was performed, while in the 52 cases a placement of a scleral flap was applied. Combined surgery - lensectomy, VPP, and an anterior chamber intraocular lens (AC IOL), was applied in 16 of the cases, and phacoemulsification, VPP and a posterior chamber intraocular lens (PC IOL) in 13 of the cases. Conclusion. Vitrectomy was the most frequently applied surgery in solving the complex eye injuries. The eye injuries treated in our department were with the IOFB, and the retinal ablation. The IOFBs in our patients were almost completely extirpated. The applied combined anterior/posterior segment surgeries had the potential to safely and successfully condense those separate procedures in one surgery. A relatively high incidence of endophthalmitis was recorded in the injuries treated in our department.