Posterior capsule rupture, iridodialysis, hyphema, and macular hole after blunt ocular trauma

Abstract

A 34-year-old man was examined 4 hours after blunt ocular trauma with a stone. Visual acuity was hand motions in the right eye and 10/10 in the left eye. Slit-lamp examination after resorption of a hyphema revealed 180◦ superior iridodialysis and a total white intumescent cataract precluding visualization of the posterior capsule. Phacoemulsification was undertaken after repositioning the iris with microretractors. Intraoperatively, we discovered that the cen-tral portion of the posterior capsule presented a 4-mm oval opening with thick and fibrosed edges. The posterior chamber lens was safely implanted in the bag with no enlargement of the posterior capsule rupture. Postoperatively, VA improved only to 1/20 and fundus OCT revealed the presence of a 400-micron, oval-shaped macular hole that was successfully closed with sub-sequent vitrectomy and gas tamponade. Visual acuity stabilized at 5/10, D3, and the lens was stable without decentration after 36 months follow-up.