In a patient presenting for cataract surgery one year after a penetrating injury with a metal wire through the limbus, iris, and lens capsule, careful preoperative evaluation is essential, including thorough slit-lamp exam and imaging to assess zonular integrity and capsular status. Surgery should begin with meticulous planning for potential complications such as zonular weakness or capsular fibrosis. During surgery, create well-placed incisions away from the previous wound to maintain structural integrity. Use capsular staining (trypan blue) to visualize the anterior capsule clearly, as fibrosis or scarring may obscure landmarks. Perform a gentle, controlled capsulorhexis, anticipating possible adhesion or irregularity at the injury site. Hydrodissection should be done cautiously to avoid capsular rupture. If zonular loss is noted, be ready to implant a capsular tension ring or segment. Remove lens material carefully, minimizing stress on the compromised capsule. Finally, implant the IOL in the capsular bag if stable; otherwise, consider sulcus placement with or without optic capture. Postoperative monitoring for inflammation or retinal complications is crucial.
