Damage to the integrity of the crystalline lens proper is a fairly common finding in the context of a serious eye injury. Either because there is no obvious pathology to the vitreous and retina or because the attending ophthalmologist does not suspect their presence, it is often an anterior segment surgeon who deals with the injured lens appreciating it as a routine cataract. A traumatic cataract, however, represents a completely different challenge, and a completely different mindset (surgical strategy) and skill set (tissue tactics) are required to provide optimal treatment. First, diagnostics. An age-related cataract rarely presents a diagnostic challenge; a traumatic one can fool the ophthalmologist in both ways (false negative or false positive diagnosis). Then there is the question of coexisting pathologies behind the lens. Finally, the crucial question whether the posterior capsule has been injured which is often difficult if not impossible to assess preoperatively. Second, the management. The patient’s age is crucial: in young ones the entire lens should be removed (both capsules) to reduce the risk of severe anterior proliferative vitreoretinopathy or the capsule’s eventual shrinkage; both can lead to irreversible phthisis. The goal of surgery is not to preserve a capsule so that an intraocular lens (IOL) can be placed (preferably in the bag) but to preserve the eyeball. If the posterior capsule is injured (or this possibility cannot be definitely excluded), phacoemulsification must not be performed because of the risk of aspirating prolapsing vitreous; in such cases lensectomy combined with (at least anterior) vitrectomy is the only safe option. The goal is not to apply the surgeon’s best-standardized cataract-removal technique but to prevent late retinal detachment caused by an iatrogenic peripheral break. Third, the IOL is typically best placed in a separate procedure once the posterior segment problems have been solved, and the type of lens to be used and its power can be optimally determined.



Ferenc KUHN
St. Johns
Email : fkuhn@mindspring.com
Cell Phone: +19044636428
Work Phone: +19044636428