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Determine the extent of trauma prior to surgery
Intraoperative surprises are not fun — they are stressful. If the extent of trauma can be determined prior to surgery, it allows the surgeon time to prepare for the upcoming challenges. In the case of a traumatic cataract, there are subtle signs that can be detected at the slit lamp before surgery.
 Extensive zonular loss after trauma. |
The 39-year-old patient in this photo developed a traumatic cataract after being struck in the eye with a soccer ball. The stellate lenticular opacity in his visual axis is easily seen, but the loss of zonules for 180° is not obvious upon first glance. When the patient gazes to the side, we can clearly see a large gap between the back of the iris and the anterior lens capsule. This black, crescent-shaped area represents extensive zonular loss. The few specks of brown iris pigment at the 9 o'clock position are not free-floating; rather, they are embedded in a tongue of vitreous that has prolapsed anteriorly.
While I was hoping to just perform a routine cataract surgery for this patient, now I know that it will be a far more extensive procedure. We'll need to address the zonular loss, reposit or remove the prolapsed vitreous, and securely place the IOL. Knowing this ahead of time gives me the opportunity to prepare an appropriate surgical strategy, set up the instrumentation needed, allot plenty of time for the case, and most of all, it will allow me to enjoy this challenging case without stress.
Get more expert perspective from Dr. Devgan live at Hawaiian Eye 2010, to be held January 17-22, 2010 at the Grand Hyatt Kauai. Learn more at OSNHawaiianEye.com.