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Abstract: Patient’s description: 3 months ago, he had a slight redness and pain in his right eye after being “stabbed by a wire”, which improved on its own after a few days without special medical attention. He was diagnosed with traumatic cataract in his right eye. After completing a comprehensive preoperative examination and evaluation, he underwent cataract ultrasound emulsification combined with IOL implantation in his right eye and postoperative adjuvant medication. One day after surgery, the vision of the right eye recovered to 0.8. The patient and his family were very satisfied with the surgical result.
Basic information】Male, 32 years old
Disease Type】Traumatic cataract
Hospital】The Third Hospital of Peking University
Date of consultation】March 2022
Treatment plan】Surgery (cataract ultrasound emulsification combined with IOL implantation) + medication (levofloxacin eye drops, prednisolone acetate eye drops, pranoprofen eye drops)
Treatment period】1 month of surgery + medication, 1 day, 1 week, 1 month, 3 months of postoperative follow-up
Effectiveness of treatment】Restored vision, healed, good treatment effect
I. Initial consultation
Patient’s description: It has been 3 months since the gradual loss of vision in the right eye, and he was diagnosed as “cataract in the right eye” at the local hospital. The patient was diagnosed as “right eye cataract” and came to our hospital for further clarification. After careful questioning of medical history, we learned that the patient was a construction worker with no systemic medical history.
Ophthalmologic examination: visual acuity of the right eye was 0.12 and that of the left eye was 1.0; intraocular pressure was normal in both eyes. Under the slit lamp, the conjunctiva of the right eye was mildly congested, the cornea was transparent, a 2-3 mm long stromal linear clouding was seen at 1 o’clock in the mid-periphery of the cornea, the depth of the anterior chamber was normal, the atrial fluid was clear, a small perforation was seen at 1 o’clock in the mid-periphery of the iris, the crystal cortex was petal-like clouding, and the fundus was unclear.
II. Treatment history
In addition to basic ophthalmic examinations such as visual acuity, intraocular pressure and slit lamp, further ocular ultrasound, orbital CT, posterior segment OCT (posterior segment optical coherence tomography) and UBM examinations were performed to understand the posterior segment of the eye, whether there was vitreous opacity, retinal detachment and intraocular foreign body residue, and to observe whether there was atrial angle, crystal dislocation and suspensory ligament rupture, etc. It was found that there was no intraocular foreign body residue, crystal dislocation, suspensory ligament abnormality and fundus abnormality. We found that there were no signs of intraocular foreign body residue, crystal dislocation, suspensory ligament abnormalities, or fundus abnormalities. In order to further develop the treatment plan, endothelial microscopy, corneal curvature measurement and ultrasound were performed, and the patient was found to have a normal corneal endothelial count that could tolerate internal eye surgery. Considering the patient’s request for improved visual acuity, the patient was recommended for surgical treatment.
In this case, the patient had a traumatic cataract with only limited clouding, and the preoperative evaluation was free of lens dislocation, suspensory ligament abnormalities, and fundus abnormalities, so simple cataract ultrasound emulsification combined with IOL implantation was considered. However, since the traumatized eye had a large corneal astigmatism and the corneal curvature was difficult to be accurately measured, the patient was referred to the contralateral eye to select the IOL to be placed. After patiently explaining the intraoperative risks and complications to the patient and completing the preoperative examination, the patient underwent cataract ultrasound-emulsification combined with IOL implantation in the right eye after day 3, and the procedure went smoothly. The patient was instructed to apply levofloxacin eye drops, prednisolone acetate eye drops and pralophine eye drops for 1 month as prescribed by the doctor. And the follow-up was reviewed at 1 day, 1 week, 1 month and 3 months after the operation.
III. Treatment effect
At the follow-up examination 1 day after the operation, the patient expressed great satisfaction that his visual acuity had improved significantly to 0.8 and he felt he had regained his sight. The slit lamp examination revealed that the patient’s cornea was clear, the anterior chamber inflammation was mild, and the IOL was in the right position. The patient was advised not to cook for 1 week, to avoid strenuous exercise, and to take eye drops on time. On reexamination 1 week after surgery, the visual acuity was still 0.8 and the anterior chamber inflammatory reaction subsided. The fundus was examined for the patient and no significant abnormality was seen either. The postoperative examination in 1 month and 3 months did not show any abnormality, the visual acuity was restored, the condition was cured, and the patient and his family were very happy with the good treatment result.
IV. Notes
We are glad that the patient recovered his vision after treatment, but we still need to pay attention to some matters in daily life: 1.
1, 1 week after surgery, do not cook, washing face, hair, bathing is theoretically possible, but it is best not to have dirty water, etc. into the eye.
2, there is no problem with daily activities, but avoid strenuous exercise activities, such as playing ball, fast running, etc., to avoid secondary damage caused by external collision of the operated eye.
3.Use eye drops regularly as required, and review the eye clinic regularly in order to detect problems and adjust eye medication in time.
V. Personal insight
Lens clouding caused by eye trauma is called traumatic cataract. Traumatic cataracts are often caused by penetrating eye injuries and ocular contusions. In addition, chemical burns, electric shock injuries and radiation injuries can also cause lens clouding. The treatment of traumatic cataract is mainly surgical. However, if the clouding is only limited, the clouding is stable and has no significant effect on vision, it can be observed, and surgery should be performed if it causes significant vision loss. However, if the lens capsule ruptures and the cortex overflows into the anterior chamber, or in patients similar to this case, mild conjunctival congestion and corneal transparency in the right eye are visible under slit lamp, surgery should be performed as early as possible to prevent secondary glaucoma. There are many factors affecting the treatment of traumatic cataracts, and a comprehensive analysis should be made based on the degree of lens clouding, the degree of capsular rupture, whether the crystal cortex is overflowing, corneal transparency and other degrees of ocular damage, with emphasis on the urgency of cataract removal and the safety of surgery. In conclusion, we remind all patients to go to a tertiary care hospital for a comprehensive evaluation as soon as possible if they are not careful about eye trauma, so as not to miss the best time for surgery.