Removal of Traumatic Cataract
A traumatic cataract may leak lens protein into the aqueous and vitreous, inciting uveitis and glaucoma. If cortical material is identified in the AC or if a mature cataract interferes with the diagnosis and treatment of injuries in the posterior segment, prompt removal of the cataract is warranted. Rupture of the capsule causes rapid hydration of the lens cortex, leading to formation of a milky-white cataract. This type of cataract is usually soft and can be aspirated through the large port of the irrigating/aspirating handpiece. It is important to be aware of the possibility of preexisting capsular rupture, which may not be visible on preoperative examination. In these cases, hydrodissection is best performed slowly to minimize the possibility of extending a capsular break and causing the lens to fall into the posterior segment.
Figure 12-12 Traumatic cataract and iridodialysis secondary to a paintball injury.
(Courtesy of Mark H. Blecher, MD.)
If a hard nuclear cataract was present before the trauma, the surgeon employs techniques for cataract removal (described in the earlier section Zonular Dehiscence With Lens Subluxation or Dislocation). An OVD can be used to provide a tamponade to anterior vitreous movement in areas of zonular incompetence. If vitreous has migrated into the anterior chamber, an anterior vitrectomy is performed before removing the lens to avoid vitreous manipulation and retinal traction.
When the nucleus is substantially subluxed and vitreous fills much of the AC, the surgeon can consider a pars plana lensectomy, in collaboration with a retinal surgeon (see BCSC Section 12, Retina and Vitreous).
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.