The surgical management
The present traumatic cataract case was treated in our department. The
procedure implied the management of the loss of posterior capsule
support with reverse optic capture. The cataract surgery was performed
combined with 23G pars plana vitrectomy. A conventional 2.4 mm clear
corneal incision was made along with paracentesis. A
360o intact continuous curvilinear capsulorhexis
(CCC), smaller than usual—-with a diameter of about 4 mm—-was
created by the use of capsulotomy forceps. Instead of a conventional
cataract surgery, the hydrodelineation of the lens nucleus was performed
without hydrodissection. The lens nucleus was extracted with low flow
settings of a phacomachine. In order to remove the cortex, slow
aspiration with manual coaxial handpiece was performed. When the
majority of the cortex was removed, an extensive PCR was observed. It
excluded the possibility of intraocular lens (IOL) implantation in the
bag. To minimise the vitreous prolapse, an injection of dispersive
viscoelastic was administered to create a tamponade near the torn part
of the capsule. A single-piece foldable IOL was implanted and stable
reverse rhexis fixation was obtained by applying a forward optic capture
technique. After stabilising the anterior chamber and hydrating the
corneal incisions, 23G pars plana vitrectomy was performed to evacuate
herniated vitreous from the posterior capsule tear and dropping cortical
fragments from the vitreous body. A standard postoperative medication,
according to the praxis of the clinic, consists of topical dexamethasone
and chloramphenicol. Consequently, it was prescribed and gradually
tapered over the period of 4 weeks.