{"paper_id":"2a46f804-b22a-41e8-920c-cf8dbde52e50","body_text":"A case report of open globe injury with iris prolapse in a geriatric patient | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case report of open globe injury with iris prolapse in a geriatric patient Mohammed Kaderi, Sachin Daigavane This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6457381/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To maintain the visual potential of individuals with open globe injuries, anatomical integrity must be restored. Preventing further tissue damage & preserving corneal shape to reduce the resulting postoperative astigmatism are the major goals of initial repair surgery. We represent a case of 70-year-old male patient reporting to the OPD of Department of Ophthalmology, with the chief complaint of pain, diminution of vision in left eye & dropping of left eyelid since 2 days, due to trauma from bulls horn. The patient was diagnosed with Aphakia/Open Globe Injury and underwent 3 surgical procedures for the rectification of complaint. First procedure was globe injury tear repair, second was scleral tuck lens implantation and finally scleral tuck lens explanation with reimplantation. The 3 surgeries took place till 2 months after reporting of the chief complaint. traumatic eye injury pain open globe injury iris prolapse aphakia Figures Figure 1 Introduction Among the leading causes of permanent visual impairment in the world are open globe injuries.[1] After ocular trauma, any of the eye's components, including the anterior and posterior segments as well as the extraocular structures, may sustain damage.[2,3] Therefore, the appropriate care of severe ocular injuries might entail all subspecialties of ophthalmology, including the departments of vitreoretinal disorders, corneal diseases, and cataracts. Because any internal or external eye structure can sustain significant damage, analysing serious ocular trauma is challenging.[2-4] Because of the wide range of potential injuries, comparative studies examining prognostic factors and management strategies for open globe injuries must include similar groups of eye injury cases. In addition to these considerations, the majority of the parameters influencing the visual prognosis overlap, making it challenging to address the therapeutic value of visual predictors in ocular trauma reports.[5,6] Phacocele, an uncommon consequence of blunt trauma, is the traumatic displacement of the crystalline lens into the subconjunctival or subtenon region. It happens when physical trauma causes the sclera to tear indirectly. The anterior subconjunctival or subtenon's space is typically where the phacocele is found. Dislocation into the posterior subtenon is extremely uncommon and might be challenging to identify. Scleral rupture is frequently linked to retinal tears & retinal detachment because of its posterior position.[7] We present a case of a 70-year-old male patient reporting with a traumatic injury, leading to the open globe injury, followed by ptosis & iris prolapse. Case presentation A 70-year-old male patient presented to the OPD of Department of Ophthalmology, AVBRH (Acharya Vinoba Bhave Rural Hospital), Sawangi, Wardha, India with the chief complaint of pain, diminution of vision in the left eye & dropping of the left eyelid since 2 days after being hit by the bull’s horn. On the first visit, the B-scan of the left eye revealed that - there was no hyperechoic membrane in the posterior vitreous and the retina was attached. The patient underwent routine checkups which included: vision- which was Hand movements close to face, perception of light present and projection of rays were accurate, eyelid showed traumatic ptosis, conjunctiva revealed chemosis and congestion. The sclera revealed a tear from the 8 O’clock position to 10 O’clock position (Figure 1A). Anterior chamber depth was shallow with 2mm hyphema present, iris tissue was prolapsed from the scleral tear and iridodialysis was present superiorly. The pupil was irregular in shape along with aphakia. Subsequently, Lens nucleus was found as a phacocele in the supero-temporal subconjunctival space (Figure 1B). Slit lamp examination was done to confirm the above-mentioned findings. The fundus examination revealed that the media was hazy & disc was hazy due to the corneal edema. Aphakia/open globe injury was made the final diagnosis. The patient had his blood investigation done for the surgeries that he would be undergoing. Within the time duration of 2 months patient underwent 3 surgeries, on the first visit it was globe injury tear repair, the second being scleral tuck lens implantation and finally scleral tuck lens explanation with reimplantation. The first surgery was done on 05/07/2024 under local anesthesia- scleral tear repair was done in the left eye under guarded visual prognosis. The patient had a scleral tear for which 5 scleral sutures were taken using 10-0 nylon-interrupted sutures and 2 conjunctival sutures using 10-0 nylon-interrupted sutures were taken to cover the scleral sutures. Anterior chamber wash was done to clear the hyphema. The dislocated lens (phacocele) was cut open by giving a nick on the conjunctiva. Anterior vitrectomy was done prior to closure. intracamerally moxifloxacin was used. The anterior chamber was formed and the scleral sutures were intact. Cornea had edema on post-op day 1, while the anterior chamber had vitreous with iris pigment dispersion, and traumatic aniridia from 8-1 O’clock position was appreciated. Oral Antibiotics and Steroids and topically moxifloxacin (0.5%) and atropine (1%) were prescribed & follow-up was scheduled after 7 days. The second surgery was scheduled on 20/08/2024 under local anesthesia in which scleral tuck lens implantation was done in the left eye under guarded visual prognosis. The patient had a vision of counting fingers at 0.5 meters distance on the day of discharge. The patient was started on steroids+ antibiotic (prednisolone 1% + moxifloxacin 0.5%) eye drop topically, soline 5% eye drop, and atropine 1% was continued & was advised to use black goggles besides being recalled after 7 days for follow-up. On the third follow-up examination, it was found that the Scleral tuck lens had decentred, Using local anesthesia scleral tuck lens explanation was done followed by reimplantation in the left eye under guarded visual prognosis. The patient was under observation for 4 days and was discharged on the same medications. His vision on the day of discharge was 6/60 while the intra-ocular pressure was 7 millimetres of mercury. Discussion One major contributor to visual morbidity is ocular trauma. The vitreous cavity is where crystalline lens dislocation happens most frequently. A phacocele is the occasional extrusion of the crystalline lens into the space of the subconjunctiva or subtenon as the consequence of indirect scleral rupture brought on by physical trauma. Fejer reported the first instance in 1928. Phacocele is uncommon and has just been documented a few decades ago.[ 7 ] Superonasal dislocation is the most frequent, followed by inferior and superotemporal dislocation. According to Arlt's idea, blunt trauma increases the equator's diameter relative to the line of impact while also decreasing the line of impact's diameter. The third most frequent location for these injuries is the spiral of Tillaux, which is directly posterior to the scleral rupture. Although it has been seen in children as young as 11, it often affects people over 40 since a stiff sclera and a well-formed crystalline lens are thought to be criteria for the condition.[ 8 ] It can happen after minor eye injuries that has been treated with surgery in the past or when systemic illnesses cause the sclera to weaken.[ 9 , 10 ] Retinal tears and retinal detachment may be linked to posterior phacocele because of the posterior position of scleral rupture. Retinal detachment surgery, scleral tear repair, and displaced lens removal are all part of the complicated therapy. Visual results might vary. Only two of the eight patients in Bhattacharjee et al.'s case series with traumatic anterior phacocele were able to attain a final visual result of 20/20.[ 8 ] Traumatic individuals are more likely to develop synechia between the anterior capsule and iris following cataract excision, and synechiolysis may be required for secondary IOL installation.[ 11 ] To determine the best time for secondary IOL implantation, adherence to treatment and follow-up is essential. The timing of cataract removal and IOL implantation are the most often debated topics in these kinds of instances.[ 11 , 12 ] According to reports, a secondary IOL implantation scheduled after the eye's irritation has subsided following first surgery can provide insight into the visual prognosis. According to Rumelt & Rehany, the timing of IOL implantation should be determined for each patient individually and based on the surgeon's experience. They also found that IOL implantation time had no influence on postoperative visual acuity in adult patients.[ 11 ] To our knowledge, He et al. conducted the sole investigation on secondary implantation of an IOL time in aphakic patients with open globe damage that has been published in the literature.[ 13 ] According to their findings, patients undergoing pars plana vitrectomy following open globe injury should wait 2.8 months between vitrectomy as well as secondary IOL implantation in order to correct aphakia. It would also be more accurate to base the decision to implant an IOL on the retina's anatomical and functional state following pars plana vitrectomy. According to He et al., there was no discernible difference in the amount of time needed for visual rehabilitation in aphakia between vitrectomy as well as secondary IOL implantation. The time to do IOL implantation in this study was 3.79 months after removing issues that might negatively impact the procedure, including the removal of corneal sutures, enhancement of corneal biomechanics, & decrease in inflammation.[ 13 ] Conclusion As soon as the patient is safe to have surgery, an ophthalmologist should begin surgical care since postoperative endophthalmitis is more likely to occur and the ultimate visual results may be poorer. A comprehensive assessment and careful consideration of the several possible investigative techniques can lead to the best results in a trauma case. The degree of severity and extent of the first injury determine the anatomical & functional results of subsequent IOL implantation following open globe injury. Declarations AUTHORS INFORMATION Dr. Mohammed Kaderi: Corresponding author (Junior Resident, Dept of Ophthalmology, Jawaharlal Nehru Medical College & Hospital, Sawangi, Wardha, India ) Email address: [email protected] Contact number: +91-8698786925 Dr. Sachin Daigavane, (HOD and Professor, Dept of Ophthalmology, Jawaharlal Nehru Medical College & Hospital, Sawangi, Wardha, India) Email address: [email protected] Contact number: +91-9021736568 Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None declared. Patient consent for publication: Obtained. CORRESPONDING AUTHOR: Mohammed Kaderi Corresponding author Email address: [email protected] Country affiliation- India References Madhusudhan P., Evelyn-Tai L. M., Zamri N., Adil H., Wan-Hazabbah W. H. Open globe injury in Hospital Universiti Sains Malaysia—a 10-year review. International Journal of Ophthalmology. 2014;7(3):486–490. doi: 10.3980/j.issn.2222-3959.2014.03.18. Bi H., Cui Y., Li Y., Wang X., Zhang J. Clinical characteristics and surgical problems of ruptured globe injury. Current Therapeutic Research—Clinical and Experimental. 2013;74:16–21. doi: 10.1016/j.curtheres.2012.10.002. Larque-Daza A. B., Peralta-Calvo J., Lopez-Andrade J. Epidemiology of openglobetrauma inthe southeast of Spain. European Journal of Ophthalmology. 2010;20(3):578–583. doi: 10.1177/112067211002000307. Hatton M. P., Thakker M. M., Ray S. Orbital and adnexal trauma associated with open-globe injuries. Ophthalmic Plastic and Reconstructive Surgery. 2002;18(6):458–461. doi: 10.1097/00002341-200211000-00013. Castellarin AA, Pieramici DJ. Open globe management. Compr Ophthalmol Update. 2007 May-Jun;8(3):111-24. https://pubmed.ncbi.nlm.nih.gov/17651540/ Gursoy H, Bilgec MD, Sahin A, Colak E. A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries. J Ophthalmol. 2017;2017:1320457. doi: 10.1155/2017/1320457. Epub 2017 Jan 12. Sindal MD, Mourya D. A rare case of traumatic posterior phacocele with retinal detachment. Indian J Ophthalmol. 2016 Jan;64(1):89-90. doi: 10.4103/0301-4738.178165. Bhattacharjee K, Bhattacharjee H, Deka A, Bhattacharyya P. Traumatic phacocele: Review of eight cases. Indian J Ophthalmol. 2007;55:466–8. doi: 10.4103/0301-4738.36487. Foroutan AR, Gheibi GH, Joshaghani M, Ahadian A, Foroutan P. Traumatic wound dehiscence and lens extrusion after penetrating keratoplasty. Cornea. 2009;28:1097–9. doi: 10.1097/ICO.0b013e3181a1645e. Sharma Y, Sudan R, Gaur A. Post traumatic subconjunctival dislocation of lens in Ehlers-Danlos syndrome. Indian J Ophthalmol. 2003;51:185–6. Rumelt S, Rehany U. The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2010;248:1293–7. doi: 10.1007/s00417-010-1378-x. Sen P, Shah C, Sen A, et al. Primary versus secondary intraocular lens implantation in traumatic cataract after open-globe injury in pediatric patients. J Cataract Refract Surg. 2018;44:1446–53. doi: 10.1016/j.jcrs.2018.07.061. He T, You C, Chen S, et al. Secondary sulcus-fixed foldable IOL implantation with 25-G infusion in patients with previous PPV after open-globe injury. Eur J Ophthalmol. 2017;27:786–90. doi: 10.5301/ejo.5000963. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6457381\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":444308631,\"identity\":\"2776ac0d-3cff-4339-b8e0-3899c9d8a0a0\",\"order_by\":0,\"name\":\"Mohammed Kaderi\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYDACHgYGiQQDmwQwJ6GAWC0PCtISGNhAWgyI1CL54MNhiBYGYrTo9hx+eCPB4Hwev3x34ocHBgzy/GIH8GsxO9tmbJFgcLtYso13M9BTDIYzZycQ0HKewQyo8nbihmO8G0BagGyCWti/AVWeA2nZ/IM4LWd7QLYcAGnZRqQtZ84UA/2SnDizLXcbkCFBhF/OpG+8+eOPXWI/89nNN39U2MjzSxPQgg4kSFM+CkbBKBgFowA7AABbxEXwM+4kIAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Datta Meghe Institute of Higher Education and Research\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Mohammed\",\"middleName\":\"\",\"lastName\":\"Kaderi\",\"suffix\":\"\"},{\"id\":444308632,\"identity\":\"c7552c5a-28e0-48f5-bea0-897a142ac6d8\",\"order_by\":1,\"name\":\"Sachin Daigavane\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Datta Meghe Institute of Higher Education and Research\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sachin\",\"middleName\":\"\",\"lastName\":\"Daigavane\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-04-15 18:38:09\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6457381/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6457381/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":81956611,\"identity\":\"f87b9977-3388-42f3-936a-a4a45e2d2e37\",\"added_by\":\"auto\",\"created_at\":\"2025-05-05 09:57:21\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":635874,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eA shows the scleral tear with the prolapsed iris tissue through it\\u003c/p\\u003e\\n\\u003cp\\u003eB shows the phacocele as described in the text above\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6457381/v1/2cc85bb4aad3c09d6ac95713.png\"},{\"id\":83389028,\"identity\":\"b1a8e7a2-1ffe-4eea-b21b-192420ca6da4\",\"added_by\":\"auto\",\"created_at\":\"2025-05-24 15:16:18\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1149753,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6457381/v1/e67ee268-ccf9-47d4-9a3a-48a84d425948.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eA case report of open globe injury with iris prolapse in a geriatric patient\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAmong the leading causes of permanent visual impairment in the world are open globe injuries.[1] After ocular trauma, any of the eye\\u0026apos;s components, including the anterior and posterior segments as well as the extraocular structures, may sustain damage.[2,3] Therefore, the appropriate care of severe ocular injuries might entail all subspecialties of ophthalmology, including the departments of vitreoretinal disorders, corneal diseases, and cataracts. Because any internal or external eye structure can sustain significant damage, analysing serious ocular trauma is challenging.[2-4] Because of the wide range of potential injuries, comparative studies examining prognostic factors and management strategies for open globe injuries must include similar groups of eye injury cases. In addition to these considerations, the majority of the parameters influencing the visual prognosis overlap, making it challenging to address the therapeutic value of visual predictors in ocular trauma reports.[5,6]\\u003c/p\\u003e\\n\\u003cp\\u003ePhacocele, an uncommon consequence of blunt trauma, is the traumatic displacement of the crystalline lens into the subconjunctival or subtenon region. It happens when physical trauma causes the sclera to tear indirectly. The anterior subconjunctival or subtenon\\u0026apos;s space is typically where the phacocele is found. Dislocation into the posterior subtenon is extremely uncommon and might be challenging to identify. Scleral rupture is frequently linked to retinal tears \\u0026amp; retinal detachment because of its posterior position.[7] We present a case of a 70-year-old male patient reporting with a traumatic injury, leading to the open globe injury, followed by ptosis \\u0026amp; iris prolapse.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Case presentation \",\"content\":\"\\u003cp\\u003eA 70-year-old male patient presented to the OPD of Department of Ophthalmology, AVBRH (Acharya Vinoba Bhave Rural Hospital), Sawangi, Wardha, India with the chief complaint of pain, diminution of vision in the left eye \\u0026amp; dropping of the left eyelid since 2 days after being hit by the bull’s horn. On the first visit, the B-scan of the left eye revealed that - there was no hyperechoic membrane in the posterior vitreous and the retina was attached. The patient underwent routine checkups which included: \\u0026nbsp;vision- which was Hand movements close to face, perception of light present and projection of rays were accurate, eyelid showed traumatic ptosis, conjunctiva revealed chemosis and congestion. The sclera revealed a tear from the 8 O’clock position to 10 O’clock position (Figure 1A). Anterior chamber depth was shallow with 2mm hyphema present, iris tissue was prolapsed from the scleral tear and iridodialysis was present superiorly. The pupil was irregular in shape along with aphakia. Subsequently, Lens nucleus was found as a phacocele in the supero-temporal subconjunctival space (Figure 1B). Slit lamp examination was done to confirm the above-mentioned findings. The fundus examination revealed that the media was hazy \\u0026amp; disc was hazy due to the corneal edema. Aphakia/open globe injury was made the final diagnosis. The patient had his blood investigation done for the surgeries that he would be undergoing. Within the time duration of 2 months patient underwent 3 surgeries, on the first visit it was globe injury tear repair, the second being scleral tuck lens implantation and finally scleral tuck lens explanation with reimplantation.\\u003c/p\\u003e\\n\\u003cp\\u003eThe first surgery was done on 05/07/2024 under local anesthesia- scleral tear repair was done in the left eye under guarded visual prognosis. The patient had a scleral tear for which 5 scleral sutures were taken using 10-0 nylon-interrupted sutures and 2 conjunctival sutures using 10-0 nylon-interrupted sutures were taken to cover the scleral sutures. Anterior chamber wash was done to clear the hyphema. The dislocated lens (phacocele) was cut open by giving a nick on the conjunctiva. Anterior vitrectomy was done prior to closure. intracamerally moxifloxacin was used. The anterior chamber was formed and the scleral sutures were intact. Cornea had edema on post-op day 1, while the anterior chamber had vitreous with iris pigment dispersion, and traumatic aniridia from 8-1 O’clock position was appreciated. Oral Antibiotics and Steroids and topically moxifloxacin (0.5%) and atropine (1%) were prescribed \\u0026nbsp;\\u0026amp; follow-up was scheduled after 7 days.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe second surgery was scheduled on 20/08/2024 under local anesthesia in which scleral tuck lens implantation was done in the left eye under guarded visual prognosis. The patient had a vision of counting fingers at 0.5 meters distance on the day of discharge. The patient was started on steroids+ antibiotic (prednisolone 1% + moxifloxacin 0.5%) eye drop topically, soline 5% eye drop, and atropine 1% was continued \\u0026amp; was advised to use black goggles besides being recalled after 7 days for follow-up.\\u003c/p\\u003e\\n\\u003cp\\u003eOn the third follow-up examination, it was found that the Scleral tuck lens had decentred, Using local anesthesia scleral tuck lens explanation was done followed by reimplantation in the left eye under guarded visual prognosis. The patient was under observation for 4 days and was discharged on the same medications. His vision on the day of discharge was 6/60 while the intra-ocular pressure was 7 millimetres of mercury.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOne major contributor to visual morbidity is ocular trauma. The vitreous cavity is where crystalline lens dislocation happens most frequently. A phacocele is the occasional extrusion of the crystalline lens into the space of the subconjunctiva or subtenon as the consequence of indirect scleral rupture brought on by physical trauma. Fejer reported the first instance in 1928. Phacocele is uncommon and has just been documented a few decades ago.[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/p\\u003e \\u003cp\\u003eSuperonasal dislocation is the most frequent, followed by inferior and superotemporal dislocation. According to Arlt's idea, blunt trauma increases the equator's diameter relative to the line of impact while also decreasing the line of impact's diameter. The third most frequent location for these injuries is the spiral of Tillaux, which is directly posterior to the scleral rupture. Although it has been seen in children as young as 11, it often affects people over 40 since a stiff sclera and a well-formed crystalline lens are thought to be criteria for the condition.[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] It can happen after minor eye injuries that has been treated with surgery in the past or when systemic illnesses cause the sclera to weaken.[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/p\\u003e \\u003cp\\u003eRetinal tears and retinal detachment may be linked to posterior phacocele because of the posterior position of scleral rupture. Retinal detachment surgery, scleral tear repair, and displaced lens removal are all part of the complicated therapy. Visual results might vary. Only two of the eight patients in Bhattacharjee et al.'s case series with traumatic anterior phacocele were able to attain a final visual result of 20/20.[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] Traumatic individuals are more likely to develop synechia between the anterior capsule and iris following cataract excision, and synechiolysis may be required for secondary IOL installation.[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e] To determine the best time for secondary IOL implantation, adherence to treatment and follow-up is essential. The timing of cataract removal and IOL implantation are the most often debated topics in these kinds of instances.[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] According to reports, a secondary IOL implantation scheduled after the eye's irritation has subsided following first surgery can provide insight into the visual prognosis. According to Rumelt \\u0026amp; Rehany, the timing of IOL implantation should be determined for each patient individually and based on the surgeon's experience. They also found that IOL implantation time had no influence on postoperative visual acuity in adult patients.[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e] To our knowledge, He et al. conducted the sole investigation on secondary implantation of an IOL time in aphakic patients with open globe damage that has been published in the literature.[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e] According to their findings, patients undergoing pars plana vitrectomy following open globe injury should wait 2.8 months between vitrectomy as well as secondary IOL implantation in order to correct aphakia. It would also be more accurate to base the decision to implant an IOL on the retina's anatomical and functional state following pars plana vitrectomy. According to He et al., there was no discernible difference in the amount of time needed for visual rehabilitation in aphakia between vitrectomy as well as secondary IOL implantation. The time to do IOL implantation in this study was 3.79 months after removing issues that might negatively impact the procedure, including the removal of corneal sutures, enhancement of corneal biomechanics, \\u0026amp; decrease in inflammation.[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eAs soon as the patient is safe to have surgery, an ophthalmologist should begin surgical care since postoperative endophthalmitis is more likely to occur and the ultimate visual results may be poorer. A comprehensive assessment and careful consideration of the several possible investigative techniques can lead to the best results in a trauma case. The degree of severity and extent of the first injury determine the anatomical \\u0026amp; functional results of subsequent IOL implantation following open globe injury.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eAUTHORS INFORMATION\\u003c/p\\u003e\\n\\u003cp\\u003eDr. Mohammed Kaderi: Corresponding author (Junior Resident, Dept of Ophthalmology, Jawaharlal Nehru Medical College \\u0026amp; Hospital, Sawangi, Wardha, India )\\u003c/p\\u003e\\n\\u003cp\\u003eEmail address: mkad11@hotmail.com\\u003c/p\\u003e\\n\\u003cp\\u003eContact number: +91-8698786925\\u003c/p\\u003e\\n\\u003cp\\u003eDr. Sachin Daigavane, (HOD and Professor, Dept of Ophthalmology, Jawaharlal Nehru Medical College \\u0026amp; Hospital, Sawangi, Wardha, India)\\u003c/p\\u003e\\n\\u003cp\\u003eEmail address: hod.ophthalmologyjnmc@gmail.com\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eContact number: +91-9021736568\\u003c/p\\u003e\\n\\u003cp\\u003eFunding:\\u0026nbsp;The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting interests:\\u0026nbsp;None declared.\\u003c/p\\u003e\\n\\u003cp\\u003ePatient consent for publication:\\u0026nbsp;Obtained.\\u003c/p\\u003e\\n\\u003cp\\u003eCORRESPONDING AUTHOR: Mohammed Kaderi\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eCorresponding author Email address: mkad11@hotmail.com\\u003c/p\\u003e\\n\\u003cp\\u003eCountry affiliation- India\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eMadhusudhan P., Evelyn-Tai L. M., Zamri N., Adil H., Wan-Hazabbah W. H. Open globe injury in Hospital Universiti Sains Malaysia\\u0026mdash;a 10-year review. International Journal of Ophthalmology. 2014;7(3):486\\u0026ndash;490. doi: 10.3980/j.issn.2222-3959.2014.03.18.\\u003c/li\\u003e\\n \\u003cli\\u003eBi H., Cui Y., Li Y., Wang X., Zhang J. Clinical characteristics and surgical problems of ruptured globe injury. Current Therapeutic Research\\u0026mdash;Clinical and Experimental. 2013;74:16\\u0026ndash;21. doi: 10.1016/j.curtheres.2012.10.002.\\u003c/li\\u003e\\n \\u003cli\\u003eLarque-Daza A. B., Peralta-Calvo J., Lopez-Andrade J. Epidemiology of openglobetrauma inthe southeast of Spain. European Journal of Ophthalmology. 2010;20(3):578\\u0026ndash;583. doi: 10.1177/112067211002000307.\\u003c/li\\u003e\\n \\u003cli\\u003eHatton M. P., Thakker M. M., Ray S. Orbital and adnexal trauma associated with open-globe injuries. Ophthalmic Plastic and Reconstructive Surgery. 2002;18(6):458\\u0026ndash;461. doi: 10.1097/00002341-200211000-00013.\\u003c/li\\u003e\\n \\u003cli\\u003eCastellarin AA, Pieramici DJ. Open globe management. Compr Ophthalmol Update. 2007 May-Jun;8(3):111-24. https://pubmed.ncbi.nlm.nih.gov/17651540/\\u003c/li\\u003e\\n \\u003cli\\u003eGursoy H, Bilgec MD, Sahin A, Colak E. A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries. J Ophthalmol. 2017;2017:1320457. doi: 10.1155/2017/1320457. Epub 2017 Jan 12.\\u003c/li\\u003e\\n \\u003cli\\u003eSindal MD, Mourya D. A rare case of traumatic posterior phacocele with retinal detachment. Indian J Ophthalmol. 2016 Jan;64(1):89-90. doi: 10.4103/0301-4738.178165.\\u003c/li\\u003e\\n \\u003cli\\u003eBhattacharjee K, Bhattacharjee H, Deka A, Bhattacharyya P. Traumatic phacocele: Review of eight cases. Indian J Ophthalmol. 2007;55:466\\u0026ndash;8. doi: 10.4103/0301-4738.36487.\\u003c/li\\u003e\\n \\u003cli\\u003eForoutan AR, Gheibi GH, Joshaghani M, Ahadian A, Foroutan P. Traumatic wound dehiscence and lens extrusion after penetrating keratoplasty. Cornea. 2009;28:1097\\u0026ndash;9. doi: 10.1097/ICO.0b013e3181a1645e.\\u003c/li\\u003e\\n \\u003cli\\u003eSharma Y, Sudan R, Gaur A. Post traumatic subconjunctival dislocation of lens in Ehlers-Danlos syndrome. Indian J Ophthalmol. 2003;51:185\\u0026ndash;6.\\u003c/li\\u003e\\n \\u003cli\\u003eRumelt S, Rehany U. The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2010;248:1293\\u0026ndash;7. doi: 10.1007/s00417-010-1378-x.\\u003c/li\\u003e\\n \\u003cli\\u003eSen P, Shah C, Sen A, et al. Primary versus secondary intraocular lens implantation in traumatic cataract after open-globe injury in pediatric patients. J Cataract Refract Surg. 2018;44:1446\\u0026ndash;53. doi: 10.1016/j.jcrs.2018.07.061.\\u003c/li\\u003e\\n \\u003cli\\u003eHe T, You C, Chen S, et al. Secondary sulcus-fixed foldable IOL implantation with 25-G infusion in patients with previous PPV after open-globe injury. Eur J Ophthalmol. 2017;27:786\\u0026ndash;90. doi: 10.5301/ejo.5000963.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"traumatic eye injury, pain, open globe injury, iris prolapse, aphakia\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6457381/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6457381/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eTo maintain the visual potential of individuals with open globe injuries, anatomical integrity must be restored. Preventing further tissue damage \\u0026amp; preserving corneal shape to reduce the resulting postoperative astigmatism are the major goals of initial repair surgery. We represent a case of 70-year-old male patient reporting to the OPD of Department of Ophthalmology, with the chief complaint of pain, diminution of vision in left eye \\u0026amp; dropping of left eyelid since 2 days, due to trauma from bulls horn. The patient was diagnosed with Aphakia/Open Globe Injury and underwent 3 surgical procedures for the rectification of complaint. First procedure was globe injury tear repair, second was scleral tuck lens implantation and finally scleral tuck lens explanation with reimplantation. The 3 surgeries took place till 2 months after reporting of the chief complaint.\\u003c/p\\u003e\",\"manuscriptTitle\":\"A case report of open globe injury with iris prolapse in a geriatric patient\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-05 09:57:16\",\"doi\":\"10.21203/rs.3.rs-6457381/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"a4a3c979-0edc-441d-a316-398bb9f93c0e\",\"owner\":[],\"postedDate\":\"May 5th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-05-24T15:08:12+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-05-05 09:57:16\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6457381\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6457381\",\"identity\":\"rs-6457381\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}