Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Traumatic Cataract Treatment & Management

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 15, 2016
 

Medical Care

If glaucoma is a problem, control intraocular pressure with standard medications. Add corticosteroids if lens particles are the cause or if iritis is present.

For focal cataract, observation is warranted if the cataract is outside the visual axis. Miotic therapy may be of benefit if the cataract is close to the visual axis.

In some cases of lens subluxation, miotics may correct monocular diplopia. Mydriatics may allow for vision around the lens with aphakic correction.

Next

Surgical Care

Planning the surgical approach is of the utmost importance in cases of traumatic cataract. Preoperative capsular integrity and zonular stability should be surmised.

In cases of posterior dislocation without glaucoma, inflammation, or visual obstruction, surgery may be avoided.

Indications for surgery include the following:

  • Unacceptable decreased vision
  • Obstructed view of posterior pathology
  • Lens-induced inflammation or glaucoma
  • Capsular rupture with lens swelling
  • Other trauma-induced ocular pathology necessitating surgery

Standard phacoemulsification may be performed if the lens capsule is intact and sufficient zonular support remains.

Intracapsular cataract extraction is required in cases of anterior dislocation or extreme zonular instability. Anterior dislocation of the lens into the anterior chamber requires emergency surgery for its removal, as it can cause pupillary block glaucoma.

Shah et al demonstrated that, as part of the primary procedure for traumatic cataract, posterior capsulectomy and anterior vitrectomy improve visual outcomes.[13] According to Trivedi and Wilson, primary posterior capsulectomy and vitrectomy should be considered irrespective of age in children undergoing surgery for traumatic cataract.[14]

Pars plana lensectomy and vitrectomy may be best in cases of posterior capsular rupture, posterior dislocation, or extreme zonular instability.

Automated irrigation/aspiration can be used in patients younger than 35 years.

Lens implantation[15] is as follows:

  • Capsular fixation is the preferred placement if the lens capsule and zonular support are intact.
  • Polymethyl methacrylate (PMMA) capsular tension rings allow capsular fixation in cases of zonular dialysis less than 180 degrees.
  • Sulcus fixation is safe if the posterior capsule is compromised but zonular support is maintained. [16]
  • Suture fixation is chosen if both capsular and zonular supports are insufficient and the angle is minimally damaged.
  • Anterior chamber placement is an option if no posterior support remains and iris or ciliary body trauma prevents suture fixation.
  • Aphakia may be a better choice in young children and in patients with highly inflamed eyes, as they may experience better outcomes if lens implantation is deferred. [17]
Previous
Next

Consultations

Vitreoretinal consultation is necessary if a pars plana approach is mandated and the surgeon is untrained in posterior segment surgery.

Previous
 
 
Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Coauthor(s)

Brian C Mulrooney, MD Private Practice, Ophthalmology, Crestwood Hospital

Brian C Mulrooney, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

References
  1. Tasman W, Jaeger EA. Traumatic cataract. Duane's Clinical Ophthalmology. 1997. 1: 13-4.

  2. Dinakaran S, Kayarkar VV. Traumatic retinal break from a viscoelastic cannula during cataract surgery. Arch Ophthalmol. 2004 Jun. 122(6):936. [Medline].

  3. Jaffe NS, Jaffe MS, Jaffe GF. Lens displacement. Cataract Surgery and Its Complications. 1997. 200-11.

  4. Sarikkola AU, Sen HN, Uusitalo RJ, Laatikainen L. Traumatic cataract and other adverse events with the implantable contact lens. J Cataract Refract Surg. 2005 Mar. 31(3):511-24. [Medline].

  5. Kanski JJ. Clinical Ophthalmology: A Systematic Approach. 1989. 257-8.

  6. Shah MA, Shah SM, Shah SB, Patel CG, Patel UA. Morphology of traumatic cataract: does it play a role in final visual outcome?. BMJ Open. 2011 Jan 1. 1(1):e000060. [Medline]. [Full Text].

  7. Schwab IR, et al. Anterior segment trauma. AAO Basic and Clinical Science Course. Section 8. 1997. 285-6.

  8. Witherspoon CD, Kunh F, Morris R, et al. Anterior and posterior segment trauma. Master Techniques in Ophthalmic Surgery. 1995. 538-47.

  9. Tabatabaei A, Kiarudi MY, Ghassemi F, Moghimi S, Mansouri M, Mirshahi A, et al. Evaluation of posterior lens capsule by 20-MHz ultrasound probe in traumatic cataract. Am J Ophthalmol. 2012 Jan. 153(1):51-4. [Medline].

  10. Kumar A, Kumar V, Dapling RB. Traumatic cataract and intralenticular foreign body. Clin Experiment Ophthalmol. 2005 Dec. 33(6):660-1. [Medline].

  11. Rofagha S, Day S, Winn BJ, Ou JI, Bhisitkul RB, Chiu CS. Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body. J Cataract Refract Surg. 2008 Jun. 34(6):1033-5. [Medline].

  12. Tabatabaei A, Hasanlou N, Kheirkhah A, Mansouri M, Faghihi H, Jafari H, et al. Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract. J Cataract Refract Surg. 2014 Jul. 40 (7):1092-6. [Medline].

  13. Shah MA, Shah SM, Patel KD, Shah AH, Pandya JS. Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy. Indian J Ophthalmol. 2014 Nov. 62 (11):1077-1081. [Medline].

  14. Trivedi RH, Wilson ME. Posterior capsule opacification in pediatric eyes with and without traumatic cataract. J Cataract Refract Surg. 2015 Jul. 41 (7):1461-4. [Medline].

  15. Chuang LH, Lai CC. Secondary intraocular lens implantation of traumatic cataract in open-globe injury. Can J Ophthalmol. 2005 Aug. 40(4):454-9. [Medline].

  16. Phillips PM, Shamie N, Chen ES, Terry MA. Transscleral sulcus fixation of a small-diameter iris-diaphragm intraocular lens in combined penetrating keratoplasty and cataract extraction for correction of traumatic cataract, aniridia, and corneal scarring. J Cataract Refract Surg. 2008 Dec. 34(12):2170-3. [Medline].

  17. Kumar S, Panda A, Badhu BP, Das H. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract. JNMA J Nepal Med Assoc. 2008 Oct-Dec. 47(172):179-85. [Medline].

  18. Shingleton BJ, Hersh PS, Kenyon KR, et al. Lens injuries. Eye Trauma. 1991. 126-34.

 
Previous
Next
 
Classic rosette-shaped cataract in a 36-year-old man, 4 weeks after blunt ocular injury.
Same cataract as seen in previous image, viewed by retroillumination.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.