Presented by: Dimitris Sakellaris MD
Edited by: Penelope Burle de Politis MD
The extraction of a traumatic cataract associated with full-thickness corneal laceration and an intraocular foreign body is neither comparable to a standard phacoemulsification procedure nor similar to an intervention for traumatic cataract without additional situations. Several variables — such as the time elapsed since the injury, the resultant ocular inflammation, the depth and extent of the ocular lesions, and the location and material of the foreign body — can all influence the eye’s condition at the time of surgery, the surgical strategy to be employed, and the postoperative outcomes.
A complex combination of trauma-induced ocular injuries may overwhelm an inexperienced ophthalmic surgeon; however, attempting to handle them all at once may prove catastrophic. Besides exercising extreme caution to avoid further damage to ocular structures — whether caused by the surgical procedure itself or by the foreign body’s harmful potential — the surgeon must be prepared to manage any unpredictable intraoperative complications. Taking an initial inventory of the lesions and addressing them one by one in a logical sequence is the safest approach.
Finally, all non-surgical penetrating eye trauma is an ophthalmic emergency and must be treated as potentially contaminated surgery. Therefore, maximum attention to prevent the further spread of microorganisms inside the eye — especially to the posterior segment, wherever possible — and broad-spectrum antibiotic coverage are paramount. Close follow-up for the assessment and timely management of eventual complications is mandatory.
In this video, recorded in the main operating room of the Ophthalmica Eye Institute in Thessaloniki, Greece, Dr. Dimitrios Sakellaris (MD), specialist in cornea and anterior segment surgery, performs a complete open-globe trauma repair on the right eye of a 56-year-old patient, sustained 5 hours earlier while hammering metal. The short time gap between injury and surgery, along with the relatively peripheral position of the corneal lesion, allowed for IOL implantation in the same procedure. Biometry was taken from the fellow eye. The surgical steps and timing in the video are as follows: side ports (00:04); methylene blue injection (00:18); primary corneal suture (00:26); main incision (01:11); identification and removal of the foreign body (01:25); two-step anterior capsulorrhexis due to ruptured anterior capsule (02:05); additional corneal suture for anterior chamber stability (03:58); aspiration of free mass (04:45); liberation of the nucleus (04:53); phacoemulsification (05:30); aspiration of cortex and membranes (09:07); IOL insertion (11:15); burying of stitches (12:24); sealing of entry sites (12:40). The procedure ends with a fully restored anterior ocular chamber and a successfully implanted in-the-bag IOL (12:58).
“All’s Well That Ends Well.” – William Shakespeare
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