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Keywords:

  • intraocular release of lens protein;
  • lens capsule disruption;
  • perforating traumatic corneal laceration;
  • phacoclastic uveitis;
  • prophylactic lens removal;
  • secondary glaucoma

Abstract

Objective  Examine prognostic factors that may indicate when surgical lens removal is indicated to prevent vision-threatening complications in patients presented following traumatic perforating corneal laceration with associated lens capsule disruption.

Procedures  Seventy-seven patients (10 cats and 67 dogs) were evaluated with this injury; of these, 47 were presented acutely and treated surgically and/or medically. Successful outcome was defined as functional vision in the treated eye.

Results  The 47 patients with acute injuries were divided into 3 treatment groups A-C for comparison; A - corneal repair/lens removal (n = 15), B - corneal repair/no lens removal (n = 9), C – medical management (n = 23). Groups A and B showed a significantly greater rate of vision loss compared to Group C that was most obvious greater than 18 months post-injury (P = 0.029 and 0.0097, respectively). Cox proportional hazards regression analysis found a significantly higher increased rate of vision loss in Group A (HR = 4.5; P = 0.023) and a higher but nonsignificant increased rate of vision loss in Group B (HR = 3.0; P = 0.23) compared to Group C after controlling for age and cause of injury. The length of the corneal laceration and time interval from injury to referral were also relevant prognostic factors.

Conclusions  Medical management is an appropriate therapy for patients of all ages suffering perforating corneal injuries with associated lens capsule disruption. Patients with corneal injuries requiring surgical repair or managed by lens removal following corneal repair suffered vision-threatening complications approximately 3 to 4.5 times the rate of patients treated by medical management, respectively. Favorable prognostic signs for treatment by medical management include good corneal wound apposition and a formed anterior chamber without uveal prolapse or continued aqueous leakage.