|Year : 2022 | Volume
| Issue : 3 | Page : 820-821
Santana Medhi, Senthil Prasad, Madhu Shekhar, SN Kamatchi
Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
|Date of Submission||10-Feb-2022|
|Date of Acceptance||17-May-2022|
|Date of Web Publication||16-Jul-2022|
Dr. Madhu Shekhar
Chief, Cataract and IOL Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai - 625 020, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Keywords: Blunt ocular trauma, posterior chamber intraocular lens, pseudophacocele, subconjunctival dislocation
|How to cite this article:|
Medhi S, Prasad S, Shekhar M, Kamatchi S N. Traumatic pseudophacocele. Indian J Ophthalmol Case Rep 2022;2:820-1
A 70-year-old female patient presented with redness, pain, and diminution of vision in her right eye (RE) since 2 months. The patient had a history of blunt trauma to her RE with a stick 2 months back. Uncorrected distance visual acuity (UDVA) was 1/60 in the RE and 6/12 in the left eye (LE). No significant ocular or systemic history was observed. The patient had undergone an uneventful manual small-incision cataract surgery (SICS) with polymethyl methacrylate (PMMA) intraocular lens (IOL) implantation in her RE 5 months back through a superior sclerocorneal incision under local anesthesia.
On examination, the RE revealed a 3-piece PMMA IOL with intact haptics lodged in the subconjunctival space in the nasal quadrant [Figure 1]a. The iris was irregular with iridodonesis and the pupil was updrawn with vitreous in the sclerocorneal tunnel superiorly. The eye was aphakic with no visible capsular support. LE was pseudophakic with a normal anterior segment. Fundus examination of RE showed mild vitreous haze and both eyes showed features of dry age-related macular degeneration (ARMD). Intraocular pressure was normal in both eyes. Ultrasound B-scan of the right eye showed multiple low-intensity echoes, suggestive of vitreous hemorrhage. There was no evidence of retinal or choroidal detachment [Figure 1]b. Based on the findings, a diagnosis of traumatic pseudophacocele with vitreous hemorrhage and dry ARMD was made.
|Figure 1: (a) Slit-lamp photography of RE showing subconjunctival dislocation of PCIOL in the nasal quadrant. (b) Ultrasound B-scan of RE showing vitreous hemorrhage|
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During surgery under local anesthesia, superior peritomy was done and the 3-piece PMMA posterior chamber intraocular lens (PCIOL) was extracted out of subconjunctival space. The subconjunctival scleral rupture was noted at the site of the cataract incision. Anterior vitrectomy was done with intrascleral haptic fixation of 3-piece IOL. Postoperatively, the best-corrected visual acuity (BCVA) was 5/60.
| Discussion|| |
Traumatic pseudophacocele associated with posterior-segment manifestation is a catastrophic complication of ocular trauma in a pseudophakic eye. Various studies in the past have reported traumatic dislocation of IOL into suprachoroidal space, vitreous cavity, and subconjunctival space. IOL dislocation in subconjunctival space was first described by Biedner et al. in 1977. Kothari et al. reported anterior dislocation of scleral fixated IOL, following blunt trauma by a cricket ball. Ocular rupture tends to occur in the superior nasal sector due to the projection of energy caused by the impact in the temporal region, where impacts occur more frequently. The predisposing factors include weakening pathologies in the eye globe such as rheumatoid arthritis, scleritis, disorders affecting the connective tissue, or weakness resulting from prior surgeries. In our case, the patient did not have any significant systemic history but there was a weakness of the sclera due to prior SICS surgery.
Diagnosis is based on meticulous history and clinical examination with the added B-scan ultrasound and ultrasound biomicroscopy (UBM). However, B-scan and UBM are relatively contraindicated in open globe injury due to the risk of infection and intraocular content extrusion. Careful ocular examination with prompt treatment can save such eyes from irreversible visual damage.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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