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G. Heidary, M. T. Andreoli, R. Wee, C. Kloek, C. M. Andreoli; Primary Intraocular Lens Implantation in Penetrating Eye Injuries. Invest. Ophthalmol. Vis. Sci. 2008;49(13):619.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the surgical outcomes of cataract extraction and primary intraocular lens implantation in the setting of acute traumatic cataract from a penetrating eye injury.
Retrospective chart review of 691 consecutive patients who presented to the Massachusetts Eye and Ear Infirmary (MEEI) between January 2001 and November 2007 with a globe rupture from a penetrating eye injury. Patients who underwent cataract extraction and primary intraocular lens implantation during the open globe repair (OGR) or within 72 hours of the OGR were included in this study. Data regarding the age, gender, time of injury, time to surgery, mechanism of injury, wound characteristics, preoperative acuity, additional surgical interventions, and data from the most recent follow up examination were recorded.
Eleven patients (82% men) were identified who fulfilled the inclusion criteria. Mean age was 32.5 yrs (range 16 to 52 yrs). Seven patients underwent lensectomy and IOL implantation at the time of the initial OGR and four within 72 hours of the initial OGR. The majority of patients presented to the emergency room at MEEI within 12 hours of the injury (9/11, 82%); one patient presented 2 days and another 8 days after the injury. Mean time from presentation to the operating room was 15 hours (range 0.75 to 81 hours). Preoperative acuity ranged from 20/20 to light perception; 4/11 (37%) patients had 20/200 or worse vision preoperatively. All wounds were classified as zone I (cornea including corneoscleral limbus). Postoperative follow up ranged from 3 to 89 months. 9 eyes had a final postoperative acuity of 20/40 or better and all eyes had a final postoperative acuity of 20/80 or better. 3/11 (27%) patients required Nd:YAG capsulotomy for posterior capsular opacification. One patient developed endophthalmitis 2 days postoperatively and was treated with a diagnostic tap and injection of intravitreal antibiotics.
The decision to implant an intraocular lens at the time of OGR still remains controversial. In a carefully selected population, outcomes tend to be extremely favorable and promote more rapid visual rehabilitation following a penetrating injury. However the occurrence of endophthalmitis in our case series raises the concern as to whether a more conservative approach of lensectomy at the time of OGR followed later with secondary IOL placement would avoid this vision threatening outcome.
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