Phacocele Induced by Traumatic Blunt Injury in a 53-Year-Old Woman: A Case Report

Abstract

Purpose: To report a 53-year-old woman with a traumatic phacocele after blunt eye trauma.

Methods: In this case, a comprehensive ophthalmological examination, computed tomography (CT), eye ultrasonography, optical coherence tomography (OCT), as well as eye and orofacial surgeries, were performed. The surgery was divided into three different stages: a revision of the wound, maxillofacial surgery, and a 25G pars plana vitrectomy with retropupillary Artisan IOL implantation.

Results: During the latest examination, occurring one and a half months after the incident, the patient presented with a best-corrected visual acuity (BCVA) of 20/70 in the left eye.

Discussion: Phacocele is a rare consequence of blunt ocular trauma, most commonly observed in elderly patients after a fall, with the lens dislocated in the superonasal quadrant. Prompt surgical management is essential, although long-term visual results may be affected by postoperative complications.

Conclusion: Phacocele, defined as the displacement of the crystalline lens into the subconjunctival space, is a rare complication that may arise from blunt eye trauma. Due to its infrequency, there is limited literature and documented cases available. As demonstrated in this case, the patient exhibited significant improvement in best-corrected visual acuity (BCVA) following surgical interventions in the eye.

Keywords: BVCA = best-corrected visual acuity; Blunt trauma; CT = computed tomography; IOL = intraocular lens; OCT = optical coherence tomography; OTS = Ophthalmic Trauma Score; crystalline lens dislocation; eye globe; phacocele; subconjunctival space.

Fig. 1

On February 29, 2024, the patient presented with diffuse conjunctival injection, nasal iridodialysis, and a dislocated crystalline lens, resulting in a bulging defect in the subconjunctival space extending from the 11 to 2 o’clock positions. The photo was captured during the initial eye operation on the day of presentation (A). The B-scan of the left eye showed severe hemophthalmos of the left eye on the day of presentation (B). The initial step of ophthalmic surgery on February 29, 2024, involved the dissection of conjunctival tissue along the 9 to 3 o’clock positions, revealing a scleral defect (C). The dissection of the bulging defect exposes tissues of the crystalline lens (D). The closure of the scleral defect using seven interrupted sutures (E). Repositioning of prolapsed scleroconjunctival tissues (F)

Fig. 2

A follow-up surgery on March 24, 2024, involved a 25-G pars plana vitrectomy (A). Removal of residual fibrotic membranes (B). Complete vitrectomy for hemophthalmos removal (C). Artisan iris-fixated intraocular lens (IOL) implantation and retropupillary securing via a corneal incision and closing the scleral wound with a cross suture (D). At the latest examination on May 3, 2024, the patient presented with a mild eye injection and a corneoscleral cross suture located at the 12 o’clock position (E). The optical coherence tomography (OCT) performed demonstrated a preserved macular structure (F)