Any mechanical or physical force that caused the crystalline lens position, stability, clarity, and capsular integrity to change is called lens injury. The mechanical forces include contused cataract, subluxation and dislocation (anteriorly into the anterior chamber or posteriorly into the vitreous cavity), perforation and penetrating injury, and intralenticular foreign bodies (siderosis bulbi, chalcosis, etc.). The physical forces include radiation (ionizing radiation, infrared radiation, ultraviolet radiation, microwave radiation, etc.), chemical injury, and electrical injury.
Lens injury demographically affects patients of all ages, with 53% of patients falling between 7 and 30 years of age. Male patients are four times more often affected than female patients (Lamkin et al., Am J Ophthalmol 113:626–631, 1992).
Sometimes contused cataract and lens dislocation occurred simultaneously in one eye. Lens injuries often combined with anterior and posterior segment injuries, such as cornea contusion, hyphema, traumatic glaucoma, iridodialysis cleft, mydriasis, cyclodialysis cleft, vitreous hemorrhage, retinal detachment, choroidal detachment, etc.
The treatment for lens injury is either medical or surgical, based on patient’s symptoms, needs, and expectations. Few mild subluxation or intralenticular foreign body composed of nonferric or non-cupric material which does not affect the vision can be managed conservatively by careful observation. Most of lens injuries, like other forms of crystalline lens pathology, require surgical intervention. The mode of surgical varies individually. Surgical extraction is the most common method. Whether the intraocular lens can be implanted or not at the meantime mainly depends on the retinal conditions. Besides, other tissues injured together also need intervention. Combined surgery was a good choice to cure other complications. Most cases had a good vision after intervention, while few patients got poor prognosis due to fundus irreversible injury.
Lens injury Contused cataract Subluxation and dislocation Perforation and penetrating injury Siderosis bulbi
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Lamkin JC, et al. Simultaneous corneal laceration repair, cataract removal, and posterior chamber intraocular lens implantation. Am J Ophthalmol. 1992;113(6):626–31.CrossRefGoogle Scholar
Salehi-Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010;50(1):167–79.CrossRefGoogle Scholar
Blecher MH, Kirk MR. Surgical strategies for the management of zonular compromise. Curr Opin Ophthalmol. 2008;19(1):31–5.CrossRefGoogle Scholar
Jacob S, et al. Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. J Cataract Refract Surg. 2003;29(2):315–21.CrossRefGoogle Scholar
Georgopoulos GT, et al. Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring. Acta Ophthalmol Scand. 2007;85(6):653–7.CrossRefGoogle Scholar
Marcus DM, Topping TM, Frederick AR Jr. Vitreoretinal management of traumatic dislocation of the crystalline lens. Int Ophthalmol Clin. 1995;35(1):139–50.CrossRefGoogle Scholar
Girard LJ, et al. Subluxated (ectopic) lenses in adults. Long-term results of pars plana lensectomy-vitrectomy by ultrasonic fragmentation with and without a phacoprosthesis. Ophthalmology. 1990;97(4):462–5.CrossRefGoogle Scholar
Peyman GA, et al. Management of subluxated and dislocated lenses with the vitrophage. Br J Ophthalmol. 1979;63(11):771–8.CrossRefGoogle Scholar
Greven CM, et al. Visual results, prognostic indicators, and posterior segment findings following surgery for cataract/lens subluxation-dislocation secondary to ocular contusion injuries. Retina. 2002;22(5):575–80.CrossRefGoogle Scholar
Kazemi S, et al. Combined pars plana lensectomy-vitrectomy with open-loop flexible anterior chamber intraocular lens (AC IOL) implantation for subluxated lenses. Trans Am Ophthalmol Soc. 2000;98:247–51. discussion 251–3.PubMedPubMedCentralGoogle Scholar
Omulecki W, Stolarska K, Synder A. Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses. J Cataract Refract Surg. 2005;31(11):2147–52.CrossRefGoogle Scholar
Yao K, et al. Phacofragmentation without perfluorocarbon liquid for dislocated crystalline lenses or lens fragments after phacoemulsification. Eur J Ophthalmol. 2002;12(3):200–4.CrossRefGoogle Scholar
Bleckmann H, Hanuschik W, Vogt R. Implantation of posterior chamber lenses in eyes with phakodonesis and lens subluxation. J Cataract Refract Surg. 1990;16(4):485–9.CrossRefGoogle Scholar
Li H, et al. Coreoplasty and Artisan intraocular lens implantation for mydriasis and aphakic correction in post-traumatic vitrectomized eyes. Eye Sci. 2012;27(3):119–23.PubMedGoogle Scholar
Coleman DJ, et al. Management of intraocular foreign bodies. Ophthalmology. 1987;94(12):1647–53.CrossRefGoogle Scholar