Eyeworld

EW CATARACT 83 March 2018 Editors' note: Dr. Tomi has no financial interests related to her comments. Contact information Tomi: ancatomi@yahoo.com overview of the damage, including damage to/rupture of the posterior capsule, the presence of vitreous hemorrhage, and retinal detach- ment. Once damage is assessed, the physician can do primary or second- ary cataract extraction and primary or secondary IOL implantation. The choice of surgery Restoring vision to an injured eye is all about the right choices, which are dictated by the degree and lo- cation of the trauma. Overall, cases in which there is a significantly disrupted anterior capsule with free floating lens matter in the anterior chamber call for primary cataract extraction, with or without IOL implantation. IOL implantation will rely on another set of criteria that surround the state of the cap- sule and zonules. If the injured eye presents a lens vitreous admixture, Dr. Tomi performs combined cata- ract extraction with limited anterior vitrectomy. When there is injury to the posterior segment, she may do an early pars plana lensectomy and a vitrectomy. Cases involving an intact anterior capsule with a total traumatic cataract require sec- ondary cataract extraction with IOL implantation. The first thing to assess when considering the implantation of an artificial lens is the patency of the posterior capsule. According to Dr. Tomi, an intact lens capsule with zonular support allows for capsular IOL fixation, the least complicat- ed scenario. In eyes with zonular dialysis of less than 180 degrees, she employs capsular tension rings to af- ford the capsule added support. Fur- ther options include sulcus fixation, sulcus suture IOLs, or if conditions allow, anterior chamber IOL place- ment. If all else fails, aphakia may not be avoidable. Choosing a lens depends on a number of factors. According to Dr. Tomi, the lens type the physician chooses is largely dependent on the patient's age, the optical and physical status of the contralateral eye, and the extent and nature of trauma to the involved eye. "De- termining the optical power of the lens to be implanted in cases with distorted anterior segment anatomy that resulted from the trauma can be difficult. You may have to use the biometry of the fellow eye. Also, the implantation of a premium IOL should not be excluded in traumat- ic eyes in cases when an accurate biometry is possible and a good centration in the bag is anticipated," she said. EW

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