• Comprehensive Ophthalmology

    Prior studies have described small series of patients with dehisced cataract surgery wounds, predominately resulting from rupture of pre-existing ECCE incisions. But there are few reports of dehisced phacoemulsification wounds. To get a better idea of the clinical course of cataract wound dehiscence, investigators retrospectively reviewed all open globe injuries treated surgically at a single center between 2000 and 2009. They found that patients with a ruptured ECCE wound have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.

    Of the 848 open globe injuries, 63 experienced cataract wound dehiscence. Most of the wounds (89 percent) occurred in patients who had extracapsular cataract extraction (ECCE), with only 7 (11 percent) occurring in patients who had phacoemulsification. Mean patient age was 78.2 years, and the majority was female.

    In the 25 patients for whom date of original cataract extraction was available, the mean time between cataract surgery and wound rupture was 102 months (range two weeks to 24 years). Mean time from surgery to rupture was 127 months in the ECCE group, compared to 3.7 months in the phacoemulsification group.

    Injuries were most commonly caused by falls (65 percent), blunt trauma (23 percent), and motor vehicle accident (7 percent). Visual acuity at presentation was light perception in the wound dehiscence group. The mean ocular trauma score was more severe for patients with wound dehiscence (48) than patients without surgical wound dehiscence (69; P < .0001).

    Preoperative visual acuities were worse in the cataract wound dehiscence group. VA was light perception in the wound dehiscence group, which was significantly worse than patients without wound dehiscence (hand motion; P = .0005). In addition, 27 percent of the wound dehiscence patients presented with an afferent pupillary defect.

    The initial open globe injury repair in the cataract wound group often required multiple procedures. Of these 63 patients, 67 percent required uveal repositioning, 24 percent underwent an anterior vitrectomy, 6 percent necessitated a lid laceration repair, and 3 percent needed disinsertion of the rectus muscles.

    Postoperative visual outcomes were worse in the cataract wound dehiscence group than in the remaining patients, (hand motion) (20/40; P = .0002). Phacoemulsification patients fared much better, with a median postoperative vision of 20/60.

    Based on the results of this study, the authors recommend ophthalmologists have a low threshold for globe exploration to exclude the possibility of a ruptured cataract wound in the pseudophakic elderly population, particularly in the setting of bullous subconjunctival hemorrhage and with poor view to the fundus. With the increasing use of small incision cataract surgery in developing countries as a primary method of cataract extraction, it remains particularly important for clinicians to be aware of these clinical signs of ruptured cataract wounds. Furthermore, patients can suffer wound dehiscence more than 20 years after surgery, suggesting that there may be no time limit on the weakness of these surgical wounds. 

    Prior studies have described small series of patients with dehisced cataract surgery wounds, predominately resulting from rupture of pre-existing ECCE incisions. But there are few reports of dehisced phacoemulsification wounds. To get a better idea of the clinical course of cataract wound dehiscence, investigators retrospectively reviewed all open globe injuries treated surgically at a single center between 2000 and 2009. They found that patients with a ruptured ECCE wound have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.

    Of the 848 open globe injuries, 63 experienced cataract wound dehiscence. Most of the wounds (89 percent) occurred in patients who had extracapsular cataract extraction (ECCE), with only 7 (11 percent) occurring in patients who had phacoemulsification. Mean patient age was 78.2 years, and the majority was female.

    In the 25 patients for whom date of original cataract extraction was available, the mean time between cataract surgery and wound rupture was 102 months (range two weeks to 24 years). Mean time from surgery to rupture was 127 months in the ECCE group, compared to 3.7 months in the phacoemulsification group.

    Injuries were most commonly caused by falls (65 percent), blunt trauma (23 percent), and motor vehicle accident (7 percent). Visual acuity at presentation was light perception in the wound dehiscence group. The mean ocular trauma score was more severe for patients with wound dehiscence (48) than patients without surgical wound dehiscence (69; P < .0001).

    Preoperative visual acuities were worse in the cataract wound dehiscence group. VA was light perception in the wound dehiscence group, which was significantly worse than patients without wound dehiscence (hand motion; P = .0005). In addition, 27 percent of the wound dehiscence patients presented with an afferent pupillary defect.

    The initial open globe injury repair in the cataract wound group often required multiple procedures. Of these 63 patients, 67 percent required uveal repositioning, 24 percent underwent an anterior vitrectomy, 6 percent necessitated a lid laceration repair, and 3 percent needed disinsertion of the rectus muscles.

    Postoperative visual outcomes were worse in the cataract wound dehiscence group than in the remaining patients, (hand motion) (20/40; P = .0002). Phacoemulsification patients fared much better, with a median postoperative vision of 20/60.

    Based on the results of this study, the authors recommend ophthalmologists have a low threshold for globe exploration to exclude the possibility of a ruptured cataract wound in the pseudophakic elderly population, particularly in the setting of bullous subconjunctival hemorrhage and with poor view to the fundus. With the increasing use of small incision cataract surgery in developing countries as a primary method of cataract extraction, it remains particularly important for clinicians to be aware of these clinical signs of ruptured cataract wounds. Furthermore, patients can suffer wound dehiscence more than 20 years after surgery, suggesting that there may be no time limit on the weakness of these surgical wounds.