Traumatic Cataract Treatment & Management
- Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD more...
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.
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. According to Trivedi and Wilson, primary posterior capsulectomy and vitrectomy should be considered irrespective of age in children undergoing surgery for traumatic cataract.
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 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. 
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. 
Vitreoretinal consultation is necessary if a pars plana approach is mandated and the surgeon is untrained in posterior segment surgery.
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