Cataract Surgery in Philadelphia After Trauma – James S. Lewis, MD

Serving Bucks County, Philadelphia, King of Prussia, Conshohocken, Warminster, Delaware Valley, Phoenixville and Montgomery County

Cataract can develop days or even years after an episode of ocular trauma. Sometimes the patient is not even aware of the significance of this injury. Trauma can also cause disruption of the zonules which support the natural lens (and cataract). Sometimes this is recognized before surgery but many times it is not revealed until after the procedure has began.

Experience with traumatized eyes undergoing cataract surgery helps one anticipate and avoid disastrous results. An unusual tissue response to the initial capsulotomy can be a a warning sign as can a subtle fluttering of the lens. Zonules, which hold the lens (now a cataract) can be likened to the ropes supporting a trampoline. Once a few are broken, the mechanical response changes. Zonular loss can be extended from a small problem to a major one if great care is not exercised.

As an FDA investigator for the Morcher Endocapsular Ring I had early access to what has become the best tool to counter the effects of zonular loss. I have implanted several hundred endocapsular rings over the last twenty years. They work by providing internal support for the capsular bag and redistributing force vectors away from the weakened zonules. Early insertion of this endoskeleton can convert a difficult case to an easy success.

Traumatized eyes can also develop glaucoma and corneal disease that should be managed at the time of cataract surgery. Cataract surgeons operating on traumatized eyes should be prepared to facilitate corneal repair, endothelial replacement, glaucoma shunt insertion, iris repair, and suturing of a posterior chamber intraocular lens.

These cases may require vitrectomy. Adequate vitreous removal can be assisted through the use of Triesence™ from Alcon. This is an excellent tool and helps minimize residual vitreal traction and thus reduce cystoid macular edema. Furthermore, the ability to perform a 25 gauge pars plana vitrectomy can improve the final results. All of our Pennsylvania cataract surgery operating suites are equipped with this specialized equipment.