[Preserving injured lenses by microsurgical management of capsule wounds. Indications, technic, results and problems]

Following perforating injuries the lens may, in rare cases, heal up with only local scarring and otherwise normal transparency. An analysis of 83 consecutively treated lens injuries and extensive experimental research have shown that this favorable course is so rare in man because the posttraumatic secretion of fibrinogen into the anterior chamber is usually insufficient. However, this can now be substituted by microsurgical treatment of the capsular lesion, including closure with human fibrinogen tissue adhesive. The method was tested on more than 200 isolated human lenses and has been applied clinically since 1982. The microsurgical procedure, including the fibrinogen application technique, is briefly described. Three cases, treated for anterior capsule injuries and through-and-through perforation of the lens, respectively, and followed up for several years, are presented. This is followed by a compilation of results in the first 31 consecutively treated patients. Among the 12 cases of anterior capsule perforation, 7 healed with acceptable visual acuity (1.0 to 0.3) even in this first series. In a total of 19 through-and-through perforations, there were only 2 good results in the first consecutive series of 15 with the method originally used. It was therefore decided to switch to translental fibrinogen application in such cases; in the following 4 patients anterior and posterior capsule wound healing and fairly good visual acuity were achieved with this technique. While the time interval between the trauma and treatment of the injury is important, the tendency toward spontaneous healing, though insufficient in the subsequent course, helps to overcome the first few hours and sometimes even days following the accident.(ABSTRACT TRUNCATED AT 250 WORDS)