Management of Traumatic Cataract with Capsular Rupture and Secondary Glaucoma Following Ocular Penetrating Injury by Automotive Door: A Case Report

Management of Traumatic Cataract with Capsular Rupture and Secondary Glaucoma Following Ocular Penetrating Injury by Automotive Door: A Case Report | 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 Management of Traumatic Cataract with Capsular Rupture and Secondary Glaucoma Following Ocular Penetrating Injury by Automotive Door: A Case Report Jian Liu, Jingwei Xu, Zhe Xu, Jiehui Xu, Wen Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6734196/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 Background Traumatic cataracts, often associated with penetrating injuries, pose significant challenges due to concurrent ocular damage. This case underscores the importance of staged surgical intervention and adaptive intraocular lens strategies in complex traumatic cataracts. Case presentation A 52-year-old male sustained left-eye injury from automotive door, resulting in corneal-conjunctival laceration, iris incarceration, traumatic cataract and secondary glaucoma. Emergency primary repair was performed, followed by secondary lensectomy, anterior vitrectomy and three-piece intraocular lens (IOL) implantation in the ciliary sulcus. Postoperative uncorrected visual acuity improved to 20/20 at 3-month follow-up. Conclusions Timely surgical repair, combined management of complications (secondary glaucoma), appropriate surgical strategies and tailored IOL implantation are critical for visual rehabilitation in complex traumatic cataracts. Traumatic Cataract Secondary Glaucoma Surgical Treatment Figures Figure 1 Background Traumatic cataracts could be found in severe eye trauma, which always accompanied with anterior or posterior segment damage. Penetrating injuries necessitate urgent repair to prevent endophthalmitis and optimize outcomes. This case highlights a penetrating ocular trauma secondary to automotive door injury combined corneal laceration, iris trauma, capsular rupture, cataract and secondary glaucoma managed through staged surgery and ultimately achieved favorable outcome. Case presentation A 52-year-old male, sustained left ocular injury caused by automotive door impact during egress from a private vehicle two hours before admission and presented with left eye temporal conjunctiva and corneal laceration, with iris prolapsed from 1–3’o clock. Emergency operations including corneoscleral suturing and iris repositioning were performed. Two days after first-stage surgery, best-corrected visual acuity (BCVA) was HM/30cm and intraocular pressure (IOP) was 35.7 mmHg in the affected eye. Slit-lamp examination showed a small amount of lens cortex in the anterior chamber. An irregularly shaped pupil with partial anterior synechia of iris was noted. No obvious capsular damage was observed in the pupillary area (Fig. 1 A). Visualization of the posterior segment remained obscured. Ultrasound biomicroscopy (UBM) revealed anterior synechiae of the iris in the temporosuperior quadrant and anterior lens capsule rupture beneath the iris. No obvious abnormalities were found in B-scan ultrasonography, optical coherence tomography (OCT) and wide-field fundus photography of left eye. Following comprehensive preoperative evaluations, phacoemulsification was performed with preparation of anterior vitrectomy. During operation, limited posterior capsule rupture (PCR) was revealed, therefore necessitating anterior vitrectomy followed and a 3-piece acrylic intraocular lens (IOL) was implanted in the ciliary sulcus. Post-operatively, the patient received conventional topical steroid therapy as routine cataract surgery. During subsequent follow-up, the BCVA was 20/20 with-1.75/-0.5×110 diopters at the first week and 20/20 with − 0.5/-1.5×42 diopters at the first month follow-up before corneal suture removal. At the third-month follow-up, the uncorrected visual acuity (UCVA) improved to 20/20. Throughout the postoperative follow-up period, the IOP has remained within normal limits, and the IOL has maintained a well-centered position. No macular edema was detected on OCT. Table 1 Clinical Datas During Follow-up BCVA IOP (mmHg) Refractive Status Corneal Endothelium (cells/mm²) Before cataract surgery HM/30cm 35.7 - 2395 1 week post cataract surgery 20/20 11.5 -1.75/-0.5×110 - 1 month post cataract surgery 20/20 10 -0.5/-1.5×42 2984 3 months post cataract surgery 20/20 8.5 - 2907 Discussion and conclusions This case presents an uncommon scenario of penetrating ocular injury due to rapid impact of the ocular globe against the sharp edge of automotive door corner when egress from a private vehicle. Ocular lacerations may be caused by any high speed impact of sharp, rigid objects on the ocular globe, such as fishing-related injuries, and even birds or crabs[1, 2]. This case emphasizes the risk generated by angular metal edges during low-velocity collisions in our daily life. Traumatic cataract and secondary glaucoma developed following occult lens injury. Assessment of posterior capsular integrity is critically significant to chose surgical strategies[1], but the presence of ruptures in both anterior and posterior lens capsules beneath the iris markedly complicates clinical management. The extrusion of lens cortex and UBM may indicate anterior capsular compromise, but detection of posterior capsular defects near the equatorial region remains challenging in acute trauma settings even with UBM and anterior segment optical coherence tomography (AS-OCT). For these patients, preparation of anterior vitrectomy for incomplete posterior capsule is essential for optimal management. Moreover, in the presence of deficient capsular support, type of IOL and implantation strategy should be selected based on lens position and the size of PCR. In cases of nondislocated cataract with intact posterior capsule or with small PCR but no vitreous loss and intact anterior capsulorhexis, foldable IOL can be placed in capsular bag or ciliary sulcus[3]. When the posterior capsule tear is large or dislocation, scleral fixated posterior chamber lenses might be used. In eyes with traumatic subluxated cataracts, capsular tension rings should be chosen to stabilize the capsule bags[4]. Postoperative visual acuity is influenced by multiple factors, such as the scarring of the corneal wound, endophthalmitis, retinal scar, or macular pucker[5, 6]. The risk of legal blindness in eyes with a posterior segment injury is almost twice that of only anterior segment injuries[7]. The Ocular Trauma Score could reliably predicting the visual outcome in traumatic cataracts poses based on an initial examination[6, 7]. Appropriate management during early post-injury phase, including promptly restoring ocular integrity, preventing endophthalmitis, and minimizing iatrogenic astigmatism, is crucial for subsequent treatments. The skills and experiences of the surgeon, preoperative, intraoperative, and postoperative complications, are also directly related to successful postoperative results[8]. For our patient, the non-central and relatively regular corneal laceration by the sharp edge of the car door minimized iatrogenic astigmatism. Timely prevention and control of potential complications such as infection and glaucoma avoided further damage to other ocular structures. The management of traumatic cataracts poses significant challenges due to the potential of cornea and iris damage, capsule rupture, lens dislocation, vitreous leak and obscured intraocular structures. Our case highlights that early implementation of standardized managements in appropriately patients is associated with favorable postoperative visual outcomes. Abbreviations IOL intraocular lens BCVA best-corrected visual acuity IOP intraocular pressure UBM ultrasound biomicroscopy OCT optical coherence tomography PCR capsule rupture UCVA uncorrected visual acuity AS-OCT anterior segment optical coherence tomography Declarations Acknowledgements None. Authors ’ contributions LJ was major contributor in writing the manuscript. XJW and XZ collected and interpreted the clinical data of the patient. XW and XJH were the total director of the study and assigned the roles to the authors. All authors read and approved the final manuscript. Funding This study was supported by a grant from the Zhejiang Provincial Natural Science Foundation (LQ24H120001) . Data availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate This study was approved by the Medical Ethics Review Board at Zhejiang Hospital of Zhejiang University. All procedures performed in the patient were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient for reporting this case. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Competing interests The authors declare no conflicts of interest in this work. References Awidi AA, Woreta FA: Corneal lacerations following crab claw injuries. Am J Ophthalmol Case Rep 2022, 25:101288. Abdulla HA, Alkhalifa SK: Ruptured Globe due to a Bird Attack. Case Rep Ophthalmol 2016, 7(1):112-114. Vajpayee RB, Sharma N, Dada T, Gupta V, Kumar A, Dada VK: Management of posterior capsule tears. Surv Ophthalmol 2001, 45(6):473-488. Taskapili M, Gulkilik G, Kocabora S, Yilmazli C, Ozsutcu M: The capsular tension ring in eyes with traumatic subluxated cataracts: a comparative study. Ann Ophthalmol (Skokie) 2008, 40(3-4):147-151. Agarwal A, Kumar DA, Nair V: Cataract surgery in the setting of trauma. Curr Opin Ophthalmol 2010, 21(1):65-70. Weinand F, Plag M, Pavlovic S: [Primary implantation of posterior chamber lenses after traumatic cataract peneration]. Ophthalmologe 2003, 100(10):843-846. Kuhn F, Morris R, Witherspoon CD, Mann L: Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol 2006, 13(3):209-216. Lacmanović Loncar V, Petric I: Surgical treatment, clinical outcomes, and complications of traumatic cataract: retrospective study. Croat Med J 2004, 45(3):310-313. Additional Declarations No competing interests reported. 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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-6734196","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":474727520,"identity":"7c5f8334-c340-4ac2-8cd0-f441df6370e0","order_by":0,"name":"Jian Liu","email":"","orcid":"","institution":"Ophthalmology Department of Zhejiang Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Liu","suffix":""},{"id":474727521,"identity":"ad26ce5c-770f-4de5-a6e5-bc20fcb95b76","order_by":1,"name":"Jingwei Xu","email":"","orcid":"","institution":"Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jingwei","middleName":"","lastName":"Xu","suffix":""},{"id":474727522,"identity":"f8a62276-7294-4ed5-9794-3b865a64459b","order_by":2,"name":"Zhe Xu","email":"","orcid":"","institution":"Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhe","middleName":"","lastName":"Xu","suffix":""},{"id":474727523,"identity":"eca2d066-7bd1-419e-8b7b-4a89ffbfb01a","order_by":3,"name":"Jiehui Xu","email":"","orcid":"","institution":"Ophthalmology Department of Zhejiang Hospital, Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jiehui","middleName":"","lastName":"Xu","suffix":""},{"id":474727524,"identity":"00cd02b1-3c3c-426e-b3d8-647de663e314","order_by":4,"name":"Wen Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYNCCCgkeefYGBgMgk7GBOC1nbOQMew6QooWxLc2Y4UYChE1Qi8GNHMPHBWyHExtnPn9QzMNgI7vhAPOzB/i0SM7IMTaewXM4sV06IcGYhyHNeMMBNnMDfFr4JXK3SfNIAG2ZnXAAqOVw4oYDPGwS+LSwSeRu/81jcDix4ebBBqCW/4S1gGxh5kkAeZ+ZAajlAGEtkj3vP0vzHAAFchqD4RyDZOOZh9nM8GoxOJ6W+Jn3Hygqjz8zeFNhJ9t3vPkZXi0o/jIARyYzsepBah+QoHgUjIJRMApGEAAAI0pGBvaBGuAAAAAASUVORK5CYII=","orcid":"","institution":"Eye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Wen","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-05-23 15:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6734196/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6734196/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85274106,"identity":"bc8c57ff-c11f-430b-8ad7-266e94f79167","added_by":"auto","created_at":"2025-06-24 06:57:13","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":703262,"visible":true,"origin":"","legend":"\u003cp\u003eMultimodal imaging of left eye. \u003cstrong\u003eA\u003c/strong\u003e:Slit-lamp images of anterior segment after emergency surgery. \u003cstrong\u003eB\u003c/strong\u003e:Ultrasound biomicroscopy (UBM) revealed anterior synechiae of the iris in the temporosuperior quadrant, rupture of the anterior lens capsule, and extrusion of cortical material. \u003cstrong\u003eC：\u003c/strong\u003eCorneal topography (Pentacam HR) revealed total corneal refractive power after emergency surgery.\u003cstrong\u003e D\u003c/strong\u003e:Slit-lamp images of the anterior segment 3 months postoperatively \u003cstrong\u003e.E\u003c/strong\u003e: The three-piece intraocular lens is centered 3 months postoperatively.\u003cstrong\u003e F\u003c/strong\u003e:Total corneal refractive power 3 months postoperatively.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6734196/v1/0a789566125a85cad56e14ba.jpeg"},{"id":87174903,"identity":"166679e9-9e6e-45d9-8eb5-f65df724fb06","added_by":"auto","created_at":"2025-07-21 08:23:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1092269,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6734196/v1/e63964e6-7537-40f4-8e48-43bf656525ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management of Traumatic Cataract with Capsular Rupture and Secondary Glaucoma Following Ocular Penetrating Injury by Automotive Door: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eTraumatic cataracts could be found in severe eye trauma, which always accompanied with anterior or posterior segment damage. Penetrating injuries necessitate urgent repair to prevent endophthalmitis and optimize outcomes. This case highlights a penetrating ocular trauma secondary to automotive door injury combined corneal laceration, iris trauma, capsular rupture, cataract and secondary glaucoma managed through staged surgery and ultimately achieved favorable outcome.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 52-year-old male, sustained left ocular injury caused by automotive door impact during egress from a private vehicle two hours before admission and presented with left eye temporal conjunctiva and corneal laceration, with iris prolapsed from 1\u0026ndash;3\u0026rsquo;o clock. Emergency operations including corneoscleral suturing and iris repositioning were performed. Two days after first-stage surgery, best-corrected visual acuity (BCVA) was HM/30cm and intraocular pressure (IOP) was 35.7 mmHg in the affected eye. Slit-lamp examination showed a small amount of lens cortex in the anterior chamber. An irregularly shaped pupil with partial anterior synechia of iris was noted. No obvious capsular damage was observed in the pupillary area (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Visualization of the posterior segment remained obscured. Ultrasound biomicroscopy (UBM) revealed anterior synechiae of the iris in the temporosuperior quadrant and anterior lens capsule rupture beneath the iris. No obvious abnormalities were found in B-scan ultrasonography, optical coherence tomography (OCT) and wide-field fundus photography of left eye.\u003c/p\u003e \u003cp\u003eFollowing comprehensive preoperative evaluations, phacoemulsification was performed with preparation of anterior vitrectomy. During operation, limited posterior capsule rupture (PCR) was revealed, therefore necessitating anterior vitrectomy followed and a 3-piece acrylic intraocular lens (IOL) was implanted in the ciliary sulcus. Post-operatively, the patient received conventional topical steroid therapy as routine cataract surgery. During subsequent follow-up, the BCVA was 20/20 with-1.75/-0.5\u0026times;110 diopters at the first week and 20/20 with \u0026minus;\u0026thinsp;0.5/-1.5\u0026times;42 diopters at the first month follow-up before corneal suture removal. At the third-month follow-up, the uncorrected visual acuity (UCVA) improved to 20/20. Throughout the postoperative follow-up period, the IOP has remained within normal limits, and the IOL has maintained a well-centered position. No macular edema was detected on OCT.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Datas During Follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIOP (mmHg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRefractive Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorneal Endothelium (cells/mm\u0026sup2;)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHM/30cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 week post cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.75/-0.5\u0026times;110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 month post cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.5/-1.5\u0026times;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months post cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion and conclusions","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eThis case presents an uncommon scenario of penetrating ocular injury due to rapid impact of the ocular globe against the sharp edge of automotive door corner when egress from a private vehicle. Ocular lacerations may be caused by any high speed impact of sharp, rigid objects on the ocular globe, such as fishing-related injuries, and even birds or crabs[1, 2]. This case emphasizes the risk generated by angular metal edges during low-velocity collisions in our daily life. Traumatic cataract and secondary glaucoma developed following occult lens injury. Assessment of posterior capsular integrity is critically significant to chose surgical strategies[1], but the presence of ruptures in both anterior and posterior lens capsules beneath the iris markedly complicates clinical management. The extrusion of lens cortex and UBM may indicate anterior capsular compromise, but detection of posterior capsular defects near the equatorial region remains challenging in acute trauma settings even with UBM and anterior segment optical coherence tomography (AS-OCT). For these patients, preparation of anterior vitrectomy for incomplete posterior capsule is essential for optimal management. Moreover, in the presence of deficient capsular support, type of IOL and implantation strategy should be selected based on lens position and the size of PCR. In cases of nondislocated cataract with intact posterior capsule or with small PCR but no vitreous loss and intact anterior capsulorhexis, foldable IOL can be placed in capsular bag or ciliary sulcus[3]. When the posterior capsule tear is large or dislocation, scleral fixated posterior chamber lenses might be used. In eyes with traumatic subluxated cataracts, capsular tension rings should be chosen to stabilize the capsule bags[4].\u003c/p\u003e \u003cp\u003ePostoperative visual acuity is influenced by multiple factors, such as the scarring of the corneal wound, endophthalmitis, retinal scar, or macular pucker[5, 6]. The risk of legal blindness in eyes with a posterior segment injury is almost twice that of only anterior segment injuries[7]. The Ocular Trauma Score could reliably predicting the visual outcome in traumatic cataracts poses based on an initial examination[6, 7]. Appropriate management during early post-injury phase, including promptly restoring ocular integrity, preventing endophthalmitis, and minimizing iatrogenic astigmatism, is crucial for subsequent treatments. The skills and experiences of the surgeon, preoperative, intraoperative, and postoperative complications, are also directly related to successful postoperative results[8]. For our patient, the non-central and relatively regular corneal laceration by the sharp edge of the car door minimized iatrogenic astigmatism. Timely prevention and control of potential complications such as infection and glaucoma avoided further damage to other ocular structures.\u003c/p\u003e \u003cp\u003eThe management of traumatic cataracts poses significant challenges due to the potential of cornea and iris damage, capsule rupture, lens dislocation, vitreous leak and obscured intraocular structures. Our case highlights that early implementation of standardized managements in appropriately patients is associated with favorable postoperative visual outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIOL intraocular lens\u003c/p\u003e\u003cp\u003eBCVA best-corrected visual acuity\u003c/p\u003e\u003cp\u003eIOP intraocular pressure\u003c/p\u003e\u003cp\u003eUBM ultrasound biomicroscopy\u003c/p\u003e\u003cp\u003eOCT optical coherence tomography\u003c/p\u003e\u003cp\u003ePCR capsule rupture\u003c/p\u003e\u003cp\u003eUCVA uncorrected visual acuity\u003c/p\u003e\u003cp\u003eAS-OCT anterior segment optical coherence tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLJ was major contributor in writing the manuscript. XJW and XZ collected and interpreted the clinical data of the patient. XW and XJH were the total director of the study and assigned the roles to the authors. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a grant from the Zhejiang Provincial Natural Science Foundation (LQ24H120001) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Review Board at Zhejiang Hospital of Zhejiang University. All procedures performed in the patient were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the patient for reporting this case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest in this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAwidi AA, Woreta FA: Corneal lacerations following crab claw injuries. Am J Ophthalmol Case Rep 2022, 25:101288.\u003c/li\u003e\n\u003cli\u003eAbdulla HA, Alkhalifa SK: Ruptured Globe due to a Bird Attack. Case Rep Ophthalmol 2016, 7(1):112-114.\u003c/li\u003e\n\u003cli\u003eVajpayee RB, Sharma N, Dada T, Gupta V, Kumar A, Dada VK: Management of posterior capsule tears. Surv Ophthalmol 2001, 45(6):473-488.\u003c/li\u003e\n\u003cli\u003eTaskapili M, Gulkilik G, Kocabora S, Yilmazli C, Ozsutcu M: The capsular tension ring in eyes with traumatic subluxated cataracts: a comparative study. Ann Ophthalmol (Skokie) 2008, 40(3-4):147-151.\u003c/li\u003e\n\u003cli\u003eAgarwal A, Kumar DA, Nair V: Cataract surgery in the setting of trauma. Curr Opin Ophthalmol 2010, 21(1):65-70.\u003c/li\u003e\n\u003cli\u003eWeinand F, Plag M, Pavlovic S: [Primary implantation of posterior chamber lenses after traumatic cataract peneration]. Ophthalmologe 2003, 100(10):843-846.\u003c/li\u003e\n\u003cli\u003eKuhn F, Morris R, Witherspoon CD, Mann L: Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol 2006, 13(3):209-216.\u003c/li\u003e\n\u003cli\u003eLacmanović Loncar V, Petric I: Surgical treatment, clinical outcomes, and complications of traumatic cataract: retrospective study. Croat Med J 2004, 45(3):310-313.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"[email protected]","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 Cataract, Secondary Glaucoma, Surgical Treatment","lastPublishedDoi":"10.21203/rs.3.rs-6734196/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6734196/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTraumatic cataracts, often associated with penetrating injuries, pose significant challenges due to concurrent ocular damage. This case underscores the importance of staged surgical intervention and adaptive intraocular lens strategies in complex traumatic cataracts.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA 52-year-old male sustained left-eye injury from automotive door, resulting in corneal-conjunctival laceration, iris incarceration, traumatic cataract and secondary glaucoma. Emergency primary repair was performed, followed by secondary lensectomy, anterior vitrectomy and three-piece intraocular lens (IOL) implantation in the ciliary sulcus. Postoperative uncorrected visual acuity improved to 20/20 at 3-month follow-up.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTimely surgical repair, combined management of complications (secondary glaucoma), appropriate surgical strategies and tailored IOL implantation are critical for visual rehabilitation in complex traumatic cataracts.\u003c/p\u003e","manuscriptTitle":"Management of Traumatic Cataract with Capsular Rupture and Secondary Glaucoma Following Ocular Penetrating Injury by Automotive Door: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 06:49:08","doi":"10.21203/rs.3.rs-6734196/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"dd778b8b-97cc-44ae-a626-6916a9c3b14e","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T08:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-24 06:49:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6734196","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6734196","identity":"rs-6734196","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}