Management of traumatic posterior capsular rupture: Corneal approach with high speed vitrector

Abstract

A 15-year-old boy was referred for reduced left-eye vision 2 weeks after a blunt trauma. The presenting visual acuities were 6/12 in the right eye and counting fingers in the left eye. Examination revealed a white cataract in the left eye with loss of convexity of the anterior lens surface. Ultrasonography confirmed a ruptured posterior capsule. Removal of the lens was approached via a clear corneal cataract incision. After insertion of an anterior chamber maintainer and capsulorhexis was performed, the lens matter was removed with vitreous cutter via the cataract incision, using its cutting and aspirating modes. A foldable intraocular lens (IOL) was inserted in the capsular bag. Visual acuity improved to 6/18 1 month after surgery and further improved to 6/6 at 6 months. The IOL was stable with no decentration or posterior capsule opacification.

Management of cataract caused by inadvertent capsule penetration during intravitreal injection of ranibizumab

“…The lens may behave similarly to a traumatic cataract or to a situation in which a capsule blowout is encountered during hydrodissection. 3 Preoperative clues to the presence of a ruptured posterior capsule may be the presence of a needle track penetrating the lens (as in our case), loss of convexity of anterior lens capsule, presence of a cataract, and demonstration of posterior capsule rupture on B-scan ultrasonography. 4 Such situations demand appropriate modification of the surgical technique.…”

“…4 Such situations demand appropriate modification of the surgical technique. 5 An anterior approach with high-speed vitrectomy cutters has been described by Li et al 3 Pavlovic 6 describes sulcus implantation of a polymethyl methacrylate IOL followed by pars plana lensectomy.…”

Cataract surgery in the setting of trauma

“…If a pre-existing tear in the anterior capsule is present one can follow the margin and complete it. Trypan blue is used to stain capsule in white cataracts, which makes the procedure simple [18,19]. In thick fibrotic capsule vannas scissors may be required to make opening in the capsule initially.…”

“…and the aspiration up to 150 mmHg has been used by Li et al [19]. Extra capsular cataract extraction (ECCE) with primary IOL implantation can be carried safely even in traumatic cataracts eyes [17,20].…”

“…In eyes with pre-existing PCR, Li et al [19] used vitreous cutter with alternate cut and aspiration mode for lens removal. Posterior capsule breaks undetected before surgery was noted with traumatic cataract by Angra et al [22].…”