Novel use of the Hoffman pocket technique in traumatic cataract with extensive zonular dialysis

Introduction: Traumatic cataracts with zonular dialysis pose significant surgical challenges. Although the Hoffman corneoscleral pocket technique is established for intraocular lens (IOL) fixation, its use in securing capsular tension segments (CTSs) is novel. Patient and Clinical Findings: A woman in her 60s with a history of blunt ocular trauma presented with a subluxated, cataractous lens and over 6 clock hours of zonular dialysis. This case report explores the adaptation of the Hoffman technique to manage this case of a traumatic cataract. Diagnosis, Intervention, and Outcomes: Preoperative slitlamp, fundus, and intraocular pressure assessments confirmed extensive zonular dialysis. The CTS was fixated using a CV-8 Gore-Tex suture through a Hoffman corneoscleral pocket, avoiding conjunctival dissection. Postoperative evaluations included visual acuity, IOP, slitlamp examination, and ultrasonography to assess IOL centration and inflammation. Uncorrected vision improved from 6/36 to 6/6 by day 1, stabilizing at 6/9. The IOL remained centered, with no evidence of decentration or recurrent inflammation. Minimal postoperative complications were observed. Conclusions: To the authors' knowledge, this is the first reported case using a Hoffman pocket to fixate a CTS in traumatic cataract. It enabled single-stage, minimally invasive surgery with excellent visual, structural, and cosmetic results while offering secure fixation. This approach warrants further exploration as an alternative to traditional scleral fixation.