![]() ![]() ![]() 2 Their study suggested that the eye with a posterior chamber lens was more resistant to trauma than eyes with the other types of artificial lenses. They also noted that rupture usually occurred at the pre-existing surgical wound site. ![]() In a clinicopathological study of ocular trauma in eyes with intraocular lenses Assia et al found, as in this case, that falling was the most common trauma to precipitate globe rupture and artificial lens extrusion. They also found in experimentation on donor human eyes that 0.68 joules of energy, which is well below that encountered in common environmental situations, could induce this injury. 3 Margel et al in their series of five cases of traumatic expulsion of posterior chamber intraocular lenses described the triad of expulsion of the lens, iris damage and intraocular haemorrhage all of which were seen in our patient. 2Ĭanavan and Archer in their study on 205 patients who had suffered contusional eye injuries found that 24.5% had lens damage but most of these were not displaced. 1 This most frequently happens in the first month after surgery but it has been described as happening on the day of surgery and up to 17 years after keratotomy. Rupture of the corneolimbic cicatrices in patients after cataract surgery is reported as happening after contusional injury. The iris fixated lenses are almost never used and the anterior chamber lens infrequently so. ![]() The posterior chamber intraocular lens is now used most frequently. The procedure has undergone many advances. Intraocular lens implantation, first performed 48 years ago, has revolutionised the treatment of patients with cataracts. A search through these 403 revealed 10 relevant articles. This database listed 18 593 articles on eye trauma with 403 on perforating eye injuries. The Pub Med Database of the United States National Library of Medicine has in excess of nine million citations of Medline and Pre-Medline Articles. Postoperatively this patient's visual acuity improved to 6/24 with pinhole and she has been subsequently listed for the placement of an anterior chamber intraocular lens implant. An anterior vitrectomy was performed and 10° nylon sutures used for wound closure. The remaining iris was retroplaced into the anterior chamber. The intraocular lens was removed through the penetrated corneal section and the incarcerated iris was dissected from the wound between ten and two clock hours. A wound swab was taken from the superior incarcerated iris for culture and sensitivities. Reconstruction of the left anterior segment was performed. The patient was subsequently transferred for ophthalmological assessment. An eye shield was used for protection to prevent further accidental extrusion of the intraocular contents. Initial management of this patient included the administration of analgesia, antiemetics, intravenous antibiotics and tetanus prophylaxis. This involved the creation of a wide corneal section superiorly to permit the expression of the cataract and to facilitate the placement of a non-foldable polymethylmethacrylate implant into the capsular bag. Operative notes revealed that the patient had undergone an uncomplicated left extracapsular cataract extraction with posterior chamber intraocular lens implantation eight years previously. ![]()
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