Traumatic cataract with secondary extreme axial elongation and posterior staphyloma: a case report

Abstract Background Traumatic cataract complicated by secondary pathologic myopia and posterior staphyloma presents significant challenges to preoperative biometry accuracy and surgical strategy selection. Reports of complex cases involving long-standing trauma (> 30 years) with secondary extreme axial length (> 29 mm) and posterior staphyloma are rare, and systematic diagnostic and therapeutic experience remains limited. Case presentation A 41-year-old male presented with a 30-year history of following a wooden stick injury. Left eye visual acuity was hand motion at 20 cm, with no improvement through either pinhole testing or refractive correction. His primary concerns included inability to perform fine visual tasks and progressive cosmetic deterioration due to esotropia. Notably, his elder sister had moderate myopia. Examination revealed characteristic “nine-petal” rosette-shaped lens opacification, an axial length of 29.99 mm, and secondary posterior staphyloma in the left eye. Diagnostic challenges included the inability to perform standard optical biometry due to the combination of dense lens opacity and posterior staphyloma, necessitating immersion B-mode ultrasound. Immersion B-mode ultrasound biometry was performed, and the Barrett TK Universal II formula was used to calculate intraocular lens (IOL) power with a target refraction of − 1.50 D. Uneventful phacoemulsification with capsular tension ring (CTR) implantation and IOL (+ 6.0 D) placement was performed. At 6-month follow-up, corrected distance visual acuity improved to 1.0 with a stable manifest refraction of − 1.75/−1.00 × 15°. No serious adverse events occurred; an unanticipated finding was a slight increase in esotropia with occasional diplopia, which did not compromise overall visual rehabilitation. Conclusions Systematic evaluation (characteristic opacification identification, immersion ultrasound biometry, and assessment of secondary anatomic alterations) combined with individualized surgical strategy (CTR implantation and Barrett formula optimization) can achieve excellent visual outcomes even in the presence of secondary pathologic myopia and posterior staphyloma. This case provides clinical guidance for managing traumatic cataract with secondary anatomic alterations and highlights the critical value of precise biometry and capsular stability management in complex cases.