Surgical management of penetrating corneal injury in a child: a case report

The article presents a case of successful visual rehabilitation of a 6-year-old child after a penetrating corneal injury. Primary surgical treatment was performed at the local hospital: the corneal wound was sutured and aspiration of the native lens was performed simultaneously due to damage to the anterior capsule. Upon admission to our clinic, based on clinical data and instrumental examination results, the child was diagnosed with membranous cataract, traumatic iris coloboma, and corneal scar of the right eye. The patient underwent anterior segment reconstruction, including removal of the fibrous pupillary membrane, implantation of a posterior chamber intraocular lens into the native capsular bag, and iris plasty for the traumatic coloboma with pupil formation. At the first stage, after preliminary conjunctival dissection in the upper quadrant, a 3.0-mm corneoscleral tunnel incision was made. A 1.0-mm corneal paracentesis was performed at the 3 o’clock position. Through the paracentesis, anterior synechiae were separated from the corneal scar zone using a blunt spatula, after which the anterior lens capsule was opened with a 30G injection needle. These steps were performed without damaging the posterior capsule, which allowed implantation of a posterior chamber intraocular lens (AcrySof IQ Natural) into the capsular bag. At the final stage of the surgery, pupil formation was performed with a 10-0 nylon suture. In the postoperative period, the patient received topical antibacterial and anti-inflammatory therapy. On the first day after surgery, uncorrected visual acuity in the right eye was 0.1. The anterior segment was nearly quiet, with single folds of the Descemet membrane in the optical zone. The anterior chamber was deep and uniform, with a 0–I degree Tyndall phenomenon; the intraocular lens was centered. The fundus reflex was pink. Ophthalmoscopy revealed no pathology of the fundus structures. At 1 month, uncorrected visual acuity in the right eye reached 0.6. The anterior segment was quiet; the optical center of the cornea was clear, and the corneal scar was competent. The anterior chamber was deep and uniform, and the intraocular lens was centered. The treatment achieved high visual function in the postoperative period and complete visual rehabilitation of the patient after severe ocular trauma.