Cataract Surgery and Cornea Laceration Repair after Trauma. Matthew Rauen Des Moines Iowa


hello this is Matthew Rauen the Wolfe Eye
Clinic we’re going to present in the case of a
traumatic cataract with corneal laceration repair it in a ten-year-old
child the child presented to us about five to
seven days after the initial trauma with this occult injury. Unfortunately,
it was a penetrating injury involving the lens capsule and cornea. The child went on to develop
the cataract over the area the corneal laceration and also this peculiar posterior
subcapsular cataract. We begin the procedure by making incisions and because there
was disruption to the anterior capsule, we use trypan blue first. We do this under air and what we’re
hoping to see where the
imperfections in the anterior capsule are, but that’s challenging to do so
were using some fiscal elastic here to flatten the anterior
capsule me and try to tease away some the lens
material that have become incorporated in the
corneal wound was interesting at this point the
procedure we didn’t need to close that wound
answer was quite a bit of fiber in this material
are present the key essentially sealed it for are gentle
intraocular procedure were using here duet forceps to tease
away any lens material on before we make our main room here use
a 2.4 millimeter care to home and we begin our
caps or axis with a bent needle take care to avoid
the area the capsular rent and as can be
visualized is on wheels in this case I’m diffusely seem to be quite good on but when we get to the area where the
lens trama kurd essentially are or capsule becomes
free-floating we have a pretty good indication that
not only is the rent in the capsule but it the rent probably travels to the the fornix of the lands we can use arm the do it four sets and scissors an effort to cleave any connections between any capsule and the corneal wound again this is a young
child so the lens is quite soft and we use the IAEA in peace to simply remove the lens material were taking
great care in the region %uh the corneal wound and
the lands trama to remove just the lens material
with hopes that the capsule remains intact as
you can see we ended up with great luck in this
regard on were removing the IA hand piece
here and we’re going to pressure I Z and tear chamber in effort to keep the poster
capsule back and any potential vitreous back now
there’s a decision to be made we ended up utilizing a single piece acrylic lens
which is our preferred lands in in this situation we
felt that comfortable placing this because love the significant capsule capsular
support that seemed to be present again it wasn’t very
gently we now need to turn our attention to the
corneal wound I in which you can see you just with
very little manipulation it’s obvious we have a full-thickness
laceration there and again this child maintain the pp a a deep anterior chamber with lands material communicating to this wound and
I’m obviously not the most stable situation
but the fact that that took place arm bought her sometime we clean up the the wound up any debris and then simply using for interrupted 10 0 nylon sutures were able to close at
one all sutures have now been removed and
fortunately the child has only about to die after za
astigmatism and we continue to to guide them through the vision rehabilitation process excellent case with again kinda been
interesting presentation as we saw it late but
fortunately we were able to achieve a good anatomical result and child again is off to a decent start
with vision

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