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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 401

Traumatic anterior dislocation of hypermature cataract: Management challenges


Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India

Date of Submission01-Aug-2020
Date of Acceptance22-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Parul Ichhpujani
Professor, Department of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh - 160 030
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2485_20

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  Abstract 


Keywords: Anterior dislocation, hypermature cataract, secondary glaucoma


How to cite this article:
Singla E, Kumar S, Ichhpujani P, Sehgal P. Traumatic anterior dislocation of hypermature cataract: Management challenges. Indian J Ophthalmol Case Rep 2021;1:401

How to cite this URL:
Singla E, Kumar S, Ichhpujani P, Sehgal P. Traumatic anterior dislocation of hypermature cataract: Management challenges. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:401. Available from: https://www.ijoreports.in/text.asp?2021/1/3/401/319994



A 50-year-old laborer presented to the ophthalmology emergency with chief complaint of diminution of vision in left eye for 15 days, associated with dull headache. Patient had history of trauma with a wooden twig a fortnight back following which he vigorously rubbed his eye and noted deterioration in vision. Additional history of old blunt trauma following assault to the same eye was also elucidated. He was diagnosed with anterior dislocation of lens at a local health setup, started on a fixed combination of brimonidine (0.2%) and timolol (0.5%) for an elevated intraocular pressure (IOP) of 42 mm Hg, and referred to a higher center. On presentation, visual acuity in left eye was hand movement close to face with accurate projection of rays. Slit lamp examination revealed edematous cornea, shallow anterior chamber (AC) with hypermature cataractous nucleus with the nuclear bag in the AC [Figure 1]a. Corneo-lenticular touch was noted infero-nasally [Figure 1]b with an IOP of 21 mm Hg. Fundus details were obscured; however, ocular ultrasound was normal. The right eye examination was unremarkable.
Figure 1: (a) Hypermature cataract with nuclear bag in AC; (b) corneo-lenticular touch; (c) post-transscleral fixation of intraocular lens

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Since our patient had presented at around the onset of COVID pandemic and the patient insisted for a single surgical procedure as he wanted to return to his village, he underwent a small incision cataract surgery followed by transcleral fixation of intraocular lens [Figure 1]c. A scleral tunnel was created through which the cataractous lens was removed after dividing it into 2 halves. Postoperative visual acuity was finger count at 1 m with accurate projection of rays with IOP in late teens without medication.


  Discussion Top


In our case, old blunt trauma might have led to zonular weakness and the recent vigorous rubbing following trauma, would have been an added insult to the hypermature cataract, eventually leading to zonular dialysis with anterior dislocation of lens. In the past spontaneous anterior dislocation of hypermature cataract has been reported but none with the capsular bag as was seen in our case.[1] The management options include lens removal ± pars plana vitrectomy.[2],[3]

Our case highlights the importance of correlation of old history in light of current findings for a planned management of hypermature cataract for a desirable visual outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahay P, Goel S, Maharana PK, Sharma N, Titiyal JS. Sequelae of neglected hypermature senile cataract. Indian J Ophthalmol 2019;67:1707-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Srećković S, Janićijević Petrović M, Jovanović S, Paunović S, Sarenac T. Traumatic anterior dislocation of the crystalline lens and its surgical management. Med Glas (Zenica) 2012;9:123-5.  Back to cited text no. 2
    
3.
Choi DY, Kim JG, Song BJ. Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma. J Cataract Refract Surg 2004;30:718-21.  Back to cited text no. 3
    


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