Intraocular Lens Implantation in Penetrating Ocular Trauma

Abstract

Approximately 55 million eye injuries limit productivity across the world yearly. 1 Open-globe injuries, defined as full-thickness wounds of the cornea and/or sclera, 2 occur with an annual incidence of 200,000 cases per year worldwide 1 and require prompt surgical intervention to minimize morbidity. 3 In cases with lens capsular violation and cataract formation, primary lensectomy has become the standard of care over the past 30 years. 4-7 However, the timing of intraocular lens (IOL) implantation after lensectomy is debated. Here, we review the literature regarding the timing of IOL implantation after penetrating ocular injury and traumatic cataract, and we provide an algorithm to help guide management in these cases. Traumatic Cataracts and the Timing of IOL ImplantationIn the 1950s and earlier, ophthalmologists treated open-globe injuries with a wide range of interventions from observation to placement of conjunctival flaps over the lacerated tissue. With the advent of intraocular air, surgeons moved towards the repositioning of intraocular structures and the reapposition of lacerated tissues. RoperHall showed convincing data that surgical repair of open-globe injuries afforded decreased morbidity. 3 As open-globe repair became standard of care, ophthalmic trauma surgeons encountered the question of what to do with traumatic cataracts during the primary repair. Roper-Hall www.internat-ophthalmology.com | 43

Sutured posterior chamber intraocular lenses for traumatic cataract in Africa

“…Better results in those patients with corneal scars is in keeping with the findings by others that patients with traumatic cataract from penetrating trauma do significantly better than those from blunt injury (7,19). Those with posterior segment injury do worse in all studies involving management of concomitant cataract (24).…”

“…Comparison with other series is therefore difficult. An excellent review article by Shah et al about intraocular lens implantation in penetrating ocular trauma does not specifically deal with cases without capsular support (7).…”

“…Several papers controversially quote youth (7) and the presence of angle or iris anomalies as contra-indications to anterior chamber lens implantation (3; 20). In our study, patient age was not significantly associated with visual outcome and our unit has traditionally avoided these lenses in traumatized eyes.…”

The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases after Open Globe Injury

“…However, secondary IOL implantation delays visual rehabilitation, impairs binocular vision, and makes amblyopia management more difficult due to the resulting high anisometropia. Furthermore, if IOL implantation is delayed, the risk of strabismus development and the need for another surgery can make the situation more complicated [7,10,12]. Both methods have their advantages and disadvantages.…”