¡¡¡¡PATIENTS AND METHODS

¡¡¡¡Patients Seventyª²three cases, age range 4 to 52 years, were treated in Chengdu Aier Eye Hospital between January 2006 and September 2008. Fortyª²five were males while 28 were females. Twentyª²seven cases were blunt trauma, while 46 cases were penetrating injuries. Some traumatic cataracts were complicated by iridodialysis, lens dislocation, vitreous hemorrhage, retinal detachment, ocular foreign body and secondary glaucoma. The best corrected preoperative visual acuity was hand moving to 0.4.

¡¡¡¡Methods We operated on all patients. (1) If there wasn¬ðt either rupture of the eye wall or large tear of lens capsule, phacoemulsification and intraocular lens(IOL) implantation were performed routinely when inflammation and hyphema disappeared. Cases with lens subluxation (zonular dialysis <150 degrees determined preoperatively or intraoperatively) required insertion of a capsular tension ring (CTR). If it was completely dislocated into the vitreous, the lens was extracted through the pars plana during posterior vitrectomy, and IOL was fixed in the ciliary sulcus 1 to 3 months later. (2) Penetrating injuries involving the anterior segment required the wounds closure immediately. Corneal lacerations were repaired with 10ª²0 sutures to form a waterª²tight closure, while rupture of scleral wall was closed with interrupted 8ª²0 sutures. Prolapsed iris or ciliary body was reposited in the globe after treated with gentamycin. If the tissue had been exposed for a long time, it was severely damaged and contaminant, the tissue out of the wound was sweeped. The root of the iris was reposited with 10ª²0 sutures through a limbal stab incision. An incision was made at the limbus, and the nucleus and cortex of the lens were removed through phacoemulsification (or extracapsular cataract extraction). Then the IOL was implanted and supported by the intact posterior capsule. If the posterior capsule was ruptured, anterior segmental vitrectomy was necessary to excise the prolapsed vitreous body. Peripheral lens capsule was preserved as far as possible to implant IOL primarily. Implantation of IOL with iridal septum was performed in patients with traumatic aniridia. (3) Penetrating injuries involving the posterior segment, such as lens luxation, vitreous hemorrhage, retinal detachment, ocular foreign bodies, required cataract removal in conjunction with vitrectomy 1ª²2 weeks after the debridement and suturing. Then IOL implantation was determined by recovery of the visual function 3ª²6 months after vitrectomy or after silicone oil removal, including implantation in the capsular bag, fixation in the ciliary sulcus with or without sutures.

¡¡¡¡RESULTS

¡¡¡¡All patients received cataract extraction and IOL implantation except 2 cases (one patient gave up surgery because of recurrence of retinal detachment, secondary IOL implantation was discontinued because of intraoperative massive suprachoroidal hemorrhage in the other case). 58/71 were implanted foldable IOL primarily or secondarily, 11/71 were performed IOL fixation in ciliary sulcus with sutures, 2/71 were implanted IOL with iridal septum, and 5/71 were inserted CTR. Five in 71(7%) cases achieved the final best spectacleª² corrected visual acuity(BSCVA) 0.05 or less, seventeen(23%) cases achieved 0.05 to 0.3, and 49 (67%) achieved 0.3 or more. Atrophy of eyeball occurred in two cases(3%). Mean followª²up time was 7.8 (range 3ª²15)months.

¡¡¡¡The early complications included corneal edema, anterior uveitis, hyphema and so on, which could be cured with active management. The late complications included central corneal scar, irregular astigmatism, slight IOL displacement, after cataract and traumatic maculopathy.

¡¡¡¡DISCUSSION

¡¡¡¡Ocular trauma is a common cause of unilateral blindness in young adults and children, among which traumatic cataracts occur frequently. Most traumatic cataracts are complicated with varied clinical manifestations, requiring different managements. Therefore, it is vital to determine appropriate surgical timing and methods.

¡¡¡¡The therapeutic principle is to restore the framework of eye globe first. We need immediate debridement and suturing of corneal or corneoscleral lacerations to avoid further damage. If only the anterior segment is involved, cataract extraction combined with primary IOL implantation is recommended[1,2]. As the cortex can escape from the tear of lens capsule into the anterior chamber and induce secondary glaucoma, traumatic uveitis, corneal endothelial decompensation and so on. Rapid cataract removal can avoid such consequences. The IOL implantation is performed simultaneously in order to alleviate patients¬ð physical and financial burdens[3]. In addition, IOL implantation is very helpful to avoid deprivation amblyopia in children with traumatic cataract[4].

¡¡¡¡The prognosis of traumatic cataract involving posterior segment is uncertain. Cataract extraction in conjunction with vitreoretinal surgery and delayed IOL implantation is recommended. Secondary IOL implantation is preferred 3ª²6 months after vitrectomy or after silicone oil removal. In this stage, status of eyeball is stable and occurrence like hemorrhage and recurrence of retinal detachment decreases. To ensure safety of operation, we put perfusion of anterior chamber to maintain interocular tention. In this case, IOL power can be calculated exactly preoperation, the postoperative complication can be minimized, and the visual outcome can be estimated. Additionally, we have to take into consideration that recurrence of retinal detachment need another surgery[5].

¡¡¡¡Above all, surgical treatment of traumatic cataract is complicated and its prognosis is uncertain. It is critical to provide rational surgical approach according to the severity of ocular trauma, effectively deal with postoperative complications and minimize ocular tissue damage to restore patient¬ðs visual function.

¡¡¡¡¡¾²Î¿¼ÎÄÏס¿

¡¡¡¡1 Moisseiev J, Segev F, Harizman,N, Arazi T, Rotenstreich Y, Assia EI. Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma. Ophthalmology2001;108(6):1099ª²1103

¡¡¡¡2 Baykara M, Dogru M, Ozcetin H, Erturk H. Primary repair and intraocular lens implantation after perforating eye injury. J Cataract Refract

¡¡¡¡Surg2002;28(10):1832ª²1835

¡¡¡¡3 Zheng GY, Wen CL, Yang JX, Zhang XF. Complicated traumatic cataract combined multiª²operation with foldable IOL implantation. Yan¡¡Waishang Zhiye Yanbing Zazhi2006;28(12):892ª²895

¡¡¡¡4 Rubsamen PE, Irvin WD, McCuen BW 2nd, Smiddy WE, Bowman CB. Primary intraocular lens implantation in the setting of penetrating ocular trauma. Ophthalmology1995;102 (1):101ª²107

¡¡¡¡5 Ke DR. 81 cases of traumatic cataract surgery. Yan Waishang Zhiye

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