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consultation section

cataract surgical problem

Section Editor(s): Masket, Samuel MD

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Journal of Cataract & Refractive Surgery: June 1999 - Volume 25 - Issue 6 - p 737
doi: 10.1016/S0886-3350(99)00099-1
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Six months earlier, a 46-year-old woman sustained a bungee cord injury to her right eye. Immediately after the injury, her vision was poor as she had sustained a traumatic hyphema. The anterior chamber hemorrhage cleared within 2 weeks, and it became evident that the lens had become significantly opaque. She has noted progressive diminution in vision in the right eye and requests visual rehabilitation.

As noted in the clinical photograph (Figure 1), the patient has an enlarged and irregular pupil. An iridodialysis is noted superotemporally, and the iris is thinned and adherent to the underlying lens capsule, also in the superotemporal region. Similarly, there is a zonular dialysis of uncertain length, allowing vitreous to herniate into the anterior chamber; liquefied vitreous occupies the central chamber. Furthermore, the lens demonstrates a cortically mature cataract with anterior capsule striae pointing toward the 12 o'clock position. The anterior chamber remains deep, and there is no suggestion of lens material or inflammatory reaction within the chamber.

Figure 1.
Figure 1.:
(Masket) A: Anterior segment examination reveals enlarged irregular pupil and cortical mature cataract. B: Slitbeam crosses lens capsule superiorly near 12 o'clock, demonstrating anterior capsule striae.

Ophthalmoscopy is greatly hindered by the cataract's density, but a gross view of the optic nerve head, macular region, and retinal periphery are unremarkable. B-scan ultrasonography demonstrates no suggestion of retinal detachment. Gonioscopy reveals multiple abnormalities including a superior angle recession and areas of peripheral anterior synechias. The pupil irregularity is the result in part of posterior synechias in addition to sphincter tears and traumatic iridoplegia. The left eye is fully normal in all aspects, and the patient presents no meaningful ocular history before the injury.

Current examination reveals visual acuity and intraocular pressure (IOP) by applanation, respectively, of 20/400 and 18 mm Hg in the right eye and 20/20 and 14 mm Hg in the left eye.

The patient uses no ocular or systemic medications. How would you approach this eye?

© 1999 by Lippincott Williams & Wilkins, Inc.