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BRIEF COMMUNICATION
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 71-73

An unusual case of penetrating trauma with a copper wire causing a traumatic subluxated cataract


Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, Goa, India

Date of Submission23-Jan-2018
Date of Acceptance11-Feb-2019
Date of Web Publication21-Aug-2019

Correspondence Address:
Marushka Aguiar
F01/02, Building 4C, Models Legacy, Near Skoda Showroom, Taleigao - 403 206, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_13_18

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  Abstract 


A 22-year-old male presented with injury with a copper wire to left eye at the workplace. Visual acuity was reduced to finger counting with severe ocular pain. Slit lamp examination showed that the intraocular foreign body entered the anterior chamber through a 0.5 mm scleral wound and pierced through iris and lens causing a traumatic cataract. The patient was taken to operatingtheater with a removal of the copper wire and primary closure of the scleral wound. Two weeks' postoperatively, the patient was taken up for a cataract surgery but left aphakic. He is to be posted for a scleral-fixated intraocular lens at a later date.

Keywords: Cataract, copper wire, trauma


How to cite this article:
Poy Raiturcar TA, Aguiar M. An unusual case of penetrating trauma with a copper wire causing a traumatic subluxated cataract. J Clin Ophthalmol Res 2019;7:71-3

How to cite this URL:
Poy Raiturcar TA, Aguiar M. An unusual case of penetrating trauma with a copper wire causing a traumatic subluxated cataract. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Nov 20];7:71-3. Available from: http://www.jcor.in/text.asp?2019/7/2/71/264889



Ocular trauma is an important cause of preventable morbidity worldwide, and a major cause of uniocular visual loss in developing countries.[1],[2]

The agents causing ocular trauma are diverse and are related to the daily activities and occupation of the person.

We present an unusual case of penetrating trauma by a copper wire at workplace causing a traumatic cataract with subluxation within a few hours of presentation.


  Case Report Top


A 22-year-old male presented to the emergency department with a history of injury to his left eye at his workplace 1 h before presentation, causing a sudden diminution of vision in the left eye to the extent of finger counting at 1 meter with severe pricking pain in that eye. There was no history of gush of warm fluid from the eye. He did not have any systemic comorbidities.

Torchlight examination showed a copper wire entering the eye through a 0.5 mm scleral wound. On slit lamp examination, it was seen that the copper wire had entered the anterior chamber through the scleral perforating wound at 5 o'clock limbus and was extending beyond the iris up to the lens which had become cataractous [Figure 1].
Figure 1: Scleral penetration with copper wire

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The cornea was clear, anterior chamber was normal in depth with no reaction or hyphema. The pupil was peaked at the 5 o'clock position with a capsular tag seen at the pupillary margin. Intraocular tension was not assessed due to the nature of injury. Fundus view was hazy but grossly within normal limits. The visual acuity of the right eye was 6/6 by Snellen chart, and anterior segment findings were unremarkable. Fundus was within normal limits. Computed tomography orbit was done to note the extent of the foreign body and removal was done according to the radiological extent noted. We advised the patient primary scleral wound repair with foreign body removal. After written, informed consent the patient was shifted to the operating theater and given peribulbar anesthesia [Figure 2].
Figure 2: Copper wire noted in anterior chamber

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After preparing and draping the eye, wire speculum was introduced and side port entry made at 11 o'clock. Viscoelastic substance was introduced into the anterior chamber through the side port. Conjunctival dissection was done to visualize site of scleral entry. The copper wire was then removed from the inferior scleral tear with McPherson's forceps [Figure 3].
Figure 3: Copper wire removed with McPherson's forceps

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Cataractous lens subluxation was noted, and so care was taken to reduce lens handling. Scleral sutures were placed [Figure 4].
Figure 4: Scleral sutures placed. Cataractous lens noted

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The patient was given a subconjunctival injection of 0.4 ml Dexamethasone (4 mg/ml) and 0.4 ml Gentamicin (20–40 mg/ml) and the eye was padded. In the ward postoperatively, he was given intravenous Cefotaxime (1.2 g 12 hourly) and Metronidazole (500 mg 8 hourly) and topically started on an antibiotic-steroid combination (Gatifloxacin 0.3% w/v + Prednisolone 1% w/v), cycloplegic eye drops (Atropine sulfate 1% w/v) thrice a day, and an antibiotic steroid eye ointment (Chloramphenicol 10 mg + Dexamethasone 1 mg + Polymyxin B 10,000 IU) at night. His vision on the first postoperative day was finger counting close to face due to the cataractous media [Figure 5].
Figure 5: First postoperative day

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Postoperative B Scan ultrasonography did not show any vitreous hemorrhage or retinal detachment. The patient was posted for extraction of the cataractous lens, 15 days after the primary procedure. Lens matter aspiration was done, and implantation of a posterior chamber intra-ocular lens attempted after peripheral automated vitrectomy but was unstable, so the patient has been left aphakic. His best-corrected visual acuity is 6/18 with a + 10 diopter lens [Figure 6].
Figure 6: Patient left aphakic

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We will consider a scleral-fixated intraocular lens implantation in this patient at a later date.


  Discussion Top


Penetrating scleral wounds with intraocular foreign body (IOFB) present a challenge to the surgeon as they require complex management for an optimal therapeutic outcome. In certain situations, it is possible to remove the penetrating foreign body and handle the associated complications in one sitting. In our case, we chose to remove the foreign body and do a primary repair of the scleral wound while postponing the cataract extraction for a later date.

Patel et al. suggested that 14% of penetrating globe injuries have IOFBs. B-scan ultrasound revealed an IOFB in 51.9% of cases and clinical examination in 45.6% of cases.[3],[4]

In our case, the foreign body was noted even clinically.

IOFB removal must be undertaken as soon as possible to prevent further complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment.

It was interesting and noteworthy to see that even after a few hours of trauma, there was the development of traumatic cataract which impaired the patient's visual acuity significantly.

We have come to learn that ocular injuries at workplace occur most commonly in young males thus debilitating them visually which could lead to a loss of livelihood.


  Conclusion Top


This case emphasizes the point that anterior and posterior segment both should be examined in detail following penetrating trauma to the eye. The use of safety devices in workplace cannot be overemphasized.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thylefors B. Epidemiological patterns of ocular trauma. Aust N Z J Ophthalmol 1992;20:95-8.  Back to cited text no. 1
    
2.
Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.  Back to cited text no. 2
    
3.
Patel SN, Langer PD, Zarbin MA, Bhagat N. Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol 2012;22:259-68.  Back to cited text no. 3
    
4.
Pokhraj PS, Jigar JP, Mehta C, Narottam AP. Intraocular metallic foreign body: Role of computed tomography. J Clin Diagn Res 2014;8:RD01-3.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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