Characteristics of Traumatic Cataract Wound Dehiscence

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02215, USA.
American Journal of Ophthalmology (Impact Factor: 3.87). 05/2011; 152(2):229-33. DOI: 10.1016/j.ajo.2011.01.044
Source: PubMed


To characterize the clinical course of cataract wound dehiscence.
Retrospective, comparative case series.
Charts of open globe injuries (848 injuries in 846 patients) treated surgically at the Massachusetts Eye and Ear Infirmary between 2000 and 2009 were retrospectively reviewed. Time from original surgery to wound dehiscence, type of initial surgery, Ocular Trauma Score, age, gender, mechanism of injury, and visual acuity were analyzed.
Of 846 patients with 848 open globe injuries, 63 experienced cataract wound dehiscence. The majority of these cataract wounds (89%) were extracapsular cataract extraction (ECCE), with only 7 (11%) phacoemulsification wounds. The mean patient age in the wound rupture group was 78.2 years. Female patients comprised the majority (67%) of this subpopulation. The most common mechanisms of injury were fall (65%), blunt trauma (23%), and motor vehicle accident (7%). The median raw ocular trauma score was 47 in wound dehiscence patients. Visual acuity at presentation was light perception in the wound dehiscence group. The best postoperative visual acuity was significantly worse in the wound dehiscence group (hand motion) than in the remaining patients (20/40; P=.0002). When considering the phacoemulsification patients alone, these patients fared much better, with a median postoperative vision of 20/60.
Despite recent advances in cataract surgery, wound dehiscence remains a significant source of visual disability, mainly in the geriatric population. Rupture ECCE wound patients have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.

Download full-text


Available from: Michael T Andreoli, May 02, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: An 83-year-old pseudophakic woman fell and sustained an open-globe injury to her left eye with traumatic aniridia, aphakia, and a total retinal detachment. Visual acuity was light perception. After primary repair of the ruptured globe, the retina was reattached using silicone oil tamponade with placement of silicone oil retention sutures to prevent the oil from touching the corneal endothelium. Three months later, the oil was removed and with glare, aphakic correction improved the patient's visual acuity to 20/80(-1). A scleral-fixated artificial iris-intraocular lens (IOL) was subsequently implanted. During placement of the IOL through a temporal corneoscleral beveled incision into the anterior chamber, the silicone oil retention sutures supported the optic as it was scleral fixated. The retention sutures aided in the placement of the IOL and prevented it from subluxating and/or dislocating during surgery. Postoperatively, the corrected visual acuity was 20/50(-2). Financial disclosure: Dr. Rosenthal is a consultant to and clinical investigator for Ophtec USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 11/2012; 38(11):2045-8. DOI:10.1016/j.jcrs.2012.08.043 · 2.72 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To describe characteristics and outcomes of fall-related open globe (OG) injuries. Methods: A total of 602 patients (603 eyes) presenting with OG injuries were included. Among them, 85 wounds (85 patients) were fall-related, which were compared with the nonfall-related OG injuries (control group). Results: The mean patient age in the fall group was 65.8 years, which was higher than the control population (35.8 years; P < 0.001). Most of the fall-related injuries occurred in women (58.8%). The most common zone injured in both groups was Zone I (38.8% and 46% in the fall and control group, respectively). Compared with the control group, patients with fall-related OG injuries had a worse visual acuity on admission and at final visit (P < 0.001). The authors performed regression analysis to characterize factors associated with developing no light perception and need for enucleation. Injuries involving Zone III and presenting vision of no light perception were associated with a higher rate of no light perception. Similarly, patients presenting with no light perception were more likely to undergo enucleation, eventually. Conclusion: Fall-related OG injuries can lead to severe ocular morbidity especially in the elderly patients. They carry a worse visual prognosis compared with other injuries, which emphasizes on the importance of protective measures in this population.
    Retina (Philadelphia, Pa.) 04/2013; 33(10). DOI:10.1097/IAE.0b013e31828abe50 · 3.24 Impact Factor

  • Digital journal of ophthalmology : DJO / sponsored by Massachusetts Eye and Ear Infirmary 08/2014; 20(2):32-4. DOI:10.5693/djo.03.2013.12.002
Show more