Ocular traumatic insult, whether penetrating or blunt, with or without prolonged visual deprivation causes ipsilateral unilateral elongation of the eyeball [1
This abnormal unilateral increase in AL is attributable to multiple factors including altered scleral
rigidity with errors in ultramicroscopic arrangement and growth of scleral fibres, increase in IOP and ocular surgeries [2
]. According to a theory, reduction in quality of retinal image also plays a role in this abnormal increase in AL, as growth of the eyeball depends on certain growth factors and the generation of these growth factors depends upon good quality retinal image [3
Earlier the age at which trauma occurs more pronounced is the increase in AL.4 Additionally, penetrating trauma causes more pronounced increase in AL as compared to blunt trauma. Similarly, more the time interval between trauma
and surgery for a visually significant cataract, more the chance of abnormal increase in AL [4
]. In both cases there was a significant increase in AL over a period.
Stimulus deprivation amblyopia is also a concern in such cases of ocular trauma due to a corneal scar and/or cataract [5
]. Under correction in these cases led to residual hyperopia to counter the myopic shift which is highly amblyogenic. Additionally, non-compliance with spectacles and the unstable refraction due to myopic shift in the post-operative period aggravates the amblyopia
. Frequent reviews and timely, prompt intervention is a must to ensure optimal visual outcome.
Keratorefractive surgeries and IOL exchange are options for such patients after their refractive status stabilizes to treat the residual refractive error. Between these two options, IOL exchange scores above keratorefractive [(Laser-Assisted in situ Keratomileusis (LASIK), Photorefractive keratectomy (PRK)] surgeries as majority of these traumatic cases are associated with corneal scar due to trauma and/or corneal tear suturing. In the first case, regular follow up and timely intervention produced good visual outcome after IOL exchange. The delayed presentation of second case led to ambylopia, resulting in limited visual recovery.
In conclusion our case report showed a significant increase in AL following trauma and highlights the importance of preventing amblyopia in traumatic cataract cases by aiming for emmetropia at every stage. The residual refractive error can be managed reasonably well with IOL exchange, even years after the primary surgery.