Management of Traumatic Cataract with Posterior Capsular Rupture: A Case Report and In Vitro Model Study

Abstract

Purpose To investigate the optimal strategy for surgical management of traumatic cataract with posterior capsular rupture. Methods We describe four cases of traumatic cataract with posterior capsular rupture and an in vitro model built to evaluate the optimal infusion pressure during surgery. Results All patients underwent cataract surgery. By using an anterior chamber maintainer to elevate infusion pressure, we safely performed cataract extraction without phacoemulsification. At 3 days after surgery, visual acuity was greater than 20/25 in all patients, without any complications. Phacoemulsification would also be feasible under anterior chamber maintainer infusion in a similar case of traumatic cataract with posterior capsular rupture during intravitreal injection. In addition, an in vitro model that we established using pig's eyes revealed that the anterior chamber remained stable when the height of infusion bottle was 50–90 mmHg, whereas shallowing of the anterior chamber occurred when the height of infusion bottle was reduced to 40 mmHg, and corneal edema occurred when the height of infusion bottle was raised to 100 mmHg. Conclusions During management of traumatic cataract with posterior capsular rupture, using an anterior chamber maintainer to maintain optimal infusion pressure may reduce the risk of anterior hyaloid membrane breakup and vitreous loss.

Isolated posterior capsule rupture after blunt eye injury

“…However, there are few literature sources on isolated PCR following a blunt eye injury. 2 The management of PCR depends on several parameters like the extent and location of the tear, the amount of residual nucleus and cortex, and the presence of vitreous in the anterior chamber. As there are limited articles reporting capsular tear fibrosis and successful IOL implantation in the bag, 2 the primary plan regarding this case was the IOL implantation in the capsular bag.…”

“…2 The management of PCR depends on several parameters like the extent and location of the tear, the amount of residual nucleus and cortex, and the presence of vitreous in the anterior chamber. As there are limited articles reporting capsular tear fibrosis and successful IOL implantation in the bag, 2 the primary plan regarding this case was the IOL implantation in the capsular bag. Considering the extension of the PCR and prolapsed vitreous in the tear, pars plana vitrectomy with lensectomy were selected as the most appropriate method for the treatment of the issue.…”

“…Blunt ocular trauma may damage the cornea, sclera, retina, and subluxate or luxate the lens. However, there are few literature sources on isolated PCR following a blunt eye injury 2 …”

“…Traumatic cataract with isolated posterior capsule rupture is a rare complication of blunt ocular trauma and therefore demands a well‐considered and diverse approach in surgical management in order to achieve a good visual outcome 1,2 . Furthermore, there is a lack of peer‐reviewed literature reporting about such type of complication 1‐5 …”