Capsular Bag Rescue in Traumatic Cataract with Extensive Zonular Dialysis: Combined CTS, CTR, Anterior Vitrectomy, and Iridodialysis Repair

Abstract: Traumatic cataract with extensive zonular dialysis presents a surgical challenge, particularly when accompanied by iris injury and vitreous prolapse. Capsular support devices may facilitate preservation of the capsular bag and in-the-bag intraocular lens (IOL) implantation. We reported a 59-year-old man presented with decreased right-eye vision after a blunt trauma from a rebounding stone. Findings included hyphema, corneal abrasion, traumatic cataract, lens subluxation, and iridodialysis. Intraocular pressure (IOP) subsequently increased to 35 mmHg. After anterior segment inflammation and IOP were controlled, phacoemulsification was performed approximately two months after injury. Intraoperative zonular dialysis extended from approximately 10 to 4 o’clock. A capsular tension segment (CTS) was secured to the sclera at a single site between 7 and 8 o’clock using a 10-0 polypropylene suture, and a capsular tension ring (CTR) provided circumferential support within the bag. A three-piece IOL was implanted in the bag. Vitreous prolapse during implantation required anterior vitrectomy, and the associated iridodialysis was repaired. At the last documented follow-up, approximately one week postoperatively, visual acuity was 6/20, improving to 6/7.5 with pinhole. IOP was 20 mmHg without pressure-lowering medication. In conclusion, a scleral-fixated CTS combined with an in-the-bag CTR permitted capsular bag preservation and IOL implantation in this eye with extensive traumatic zonular dialysis. Associated vitreous prolapse and iridodialysis were addressed during the same operation. Longer follow-up is needed to assess sustained visual recovery and bag–IOL stability. Keywords: traumatic cataract; zonular dialysis; capsular tension segment; capsular tension ring