Comprehensive surgical management of traumatic cataract with scleral fixation of an intraocular lens in phacolytic glaucoma

Purpose

.  To evaluate the clinical and functional outcomes of surgical treatment in patients with traumatic cataract complicated by phacolytic glaucoma using scleral fixation of an intraocular lens (IOL).

Methods

. This was a retrospective study that included 34 patients (34 eyes) with traumatic cataract and phacolytic glaucoma who underwent surgery at the Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy in 2019–2024. All patients underwent cataract extraction with simultaneous scleral fixation of a posterior chamber IOL using a suture technique with 8-0 polypropylene. Changes in visual acuity and intraocular pressure (IOP), as well as the incidence of intraoperative and postoperative complications, were assessed. The follow-up period was 12 months.

Results

.  The mean age of the patients was 47.3±12.8 years; 25 patients were men and 9 were women. Baseline visual acuity was 1.84±0.42 logMAR, and IOP was 38.6± 5.2 mm Hg. At 12 months, visual acuity improved to 0.38± 0.21 logMAR (p < 0.001), and IOP decreased to 18.3±2.4 mm Hg (p < 0.001). IOP normalization without hypotensive medications was achieved in 29 patients (85.3%). Intraoperative complications included vitreous hemorrhage in 2 cases (5.9%) and hypotony in 1 case (2.9%). Postoperative complications included transient ocular hypertension in 4 cases (11.8%) and cystoid macular edema in 2 cases (5.9%). IOL centration was assessed as excellent in 30 eyes (88.2%) and satisfactory in 4 eyes (11.8%); no IOL dislocation was observed.

Conclusion

.  Scleral IOL fixation using 8-0 polypropylene is an effective and safe method of surgical rehabilitation in patients with traumatic cataract complicated by phacolytic glaucoma. The technique provides sustained IOP normalization, high visual function, and a low complication rate.