A 74-year-old female patient attended the emergency department because she had suffered an accidental blunt trauma at home, of moderate intensity to the left eye (OI), after hitting it with the edge of the bedside table.
His medical history included mild ametropia without optical correction and type 2 diabetes mellitus under treatment with oral antidiabetic drugs. He had no other personal or family history of interest.
His visual acuity (VA) was 0.6 in the right eye and light perception did not improve with pinhole in the right eye. Slit-lamp examination revealed haematoma and oedema in the left upper eyelid, intact conjunctiva with intense generalised chemosis, intact and transparent cornea and 100% hyphaema that prevented assessment of the rest of the ocular structures. OI hypotony was observed with an intraocular pressure of 5 mm Hg.
Imaging tests (computed tomography and magnetic resonance imaging) revealed an incised upper nasal paralimbal scleral incision wound of approximately 10 mm and the presence of a prolapsed intact lens in the subconjunctival space.
The conjunctival chemosis rapidly evolved into generalised hyposphagma, revealing an upper nasal subconjunctival mass corresponding to the prolapsed lens.
The patient underwent a 360º peritomy, extraction of the prolapsed lens, suture of the scleral wound and treatment with intravenous and reinforced topical antibiotherapy.
One month after surgery, the patient's hand movement VA improved to 0.1 with correction of +14.00 dioptres. The slit lamp showed a clear cornea, upper nasal corectopia with loss of iridian tissue and adherent debris. The fundus, which was not visible due to media opacity, showed retina in situ in the B-mode ultrasound.
At twelve months, combined vitrectomy via pars plana and suture of the intraocular lens to the sulcus was performed, achieving a spontaneous VA of 0.3 at eighteen months.