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Traumatic Bulbus Rupture after Cataract Surgery: Accident Mechanisms and Morphological Findings
Kono Kono J. O., Klaeßen D., Wegner A., Lanzl I.,
Technische Universität München, Klinikum rechts der Isar, Augenklinik (München)
Purpose: Blunt trauma causing disruption of cornea and/or sclera has a bad prognosis regarding visual acuity and is frequently the reason for ensuing enucleation. Rupture of the globe after preceding cataract surgery is accompanied with major complications. Accident mechanisms, morphologic findings, and healing process in the reference to the obtained visual acuity are analysed in our investigation.
Method: Prospective analysis of 18 patients (18 eyes), who were treated between 1996 to 2000 in our department with ruptured globe due to blunt trauma after prior cataract surgery. The mean observation period was 1.4 years.
Results: The majority of patients were female (77 %). 17 of the 18 patients were older than 75 years. Traumata occurred after fall (n=12), punch (n=3), hitting a hard object with the head (n=2) and air bag use in a car (n=1). All patients had undergone a lens extraction previously. 15 had received a posterior chamber lens, in 3 patients location of the previously implanted lens could not be determined. In 5 patients a fracture of the bone was associated with the injury. Morphologically we found corneal injuries (n=1), corneoscleral injuries (n=6) and injuries parallel to the limbus (n=11), hyphema (n=18), traumatic aniridia (n=8), vitreous prolapse (n=13) and retinal detachment (n=14). The best corrected visual acuity remained in half of the patients below 0,1. Two eyes were enucleated. A vitreous prolapse and a retinal detachment proved to be prognostic factors predicting limited visual acuity outcome.
Conclusions: Traumatic rupture of the globe after previous cataract extraction is a serious injury occurring mostly in older and multimorbid patients. Information of patients and their families about risks of traumatic events when falling, and possibly a change in the home environment might be able to lower the number of patients with traumatic globe rupture.