BELGRADE, Serbia — Cataract surgery has a low complication rate and is the most common, highly standardized procedure in the world, but there are no rules or pre-established patterns when cataract occurs in a traumatized eye.
“Traumatic cataract is another operation entirely. In trauma cases, there is no limits to what might happen and what might be needed, and this includes temporary keratoprosthesis with a complete mess inside the eye,” Ferenc Kuhn, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting. “If you don’t plan your surgery in terms of who is doing it, when and how, and what is needed, you will run into a lot of problems, including loss of the eye.”
Phacoemulsification may not be the best choice for traumatic cataract, due to the likely occurrence of vitreous prolapse.
“If you don’t realize that vitreous has prolapsed into the anterior segment, you might aspirate it without cutting, causing severe damage to the retina,” he said.
He emphasized that IOL implantation should not be the primary focus, particularly in eyes in which the damage is extended to the posterior segment. Saving the eyeball, the retina and the ciliary body comes first, and rarely can an IOL be implanted at the same time of cataract surgery.
“If you implant the lens and then you have a secondary complication in the retina, the edge of the IOL can be very bothersome,” he said.
In-the-bag implantation is rarely the best option. Kuhn recommended the implantation of an iris-claw lens behind the iris even in cases in which the iris has been previously sutured.
“Very often, in about 50% of eyes, you will have to do posterior segment surgery as well. If you concentrate on the IOL in the bag, rather than on the eye as a whole, then you will force your own surgical technique on the eye rather than doing the other way around, which is individualize your technique according to the needs of the case,” Kuhn said. – by Michela Cimberle
Kuhn F. Lens injury in the context of severe ocular trauma. Presented at the European Society of Cataract and Refractive Surgeons winter meeting; Feb. 9-11, 2018; Belgrade, Serbia.
Disclosure: Kuhn reports no relevant financial disclosures.