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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 17  |  Issue : 2  |  Page : 56-58

Outcome after cataract surgery in patients with traumatic cataract


Department of Ophthalmology, Pravara Institute of Medical Sciences, Rural Medical College, Loni, Maharashtra, India

Date of Submission03-Dec-2015
Date of Acceptance06-Feb-2016
Date of Web Publication30-Aug-2016

Correspondence Address:
Akshay J Bhandari
Department of Ophthalmology, Pravara Institute of Medical Sciences, Rural Medical College, Loni - 413 736, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-9173.189074

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  Abstract 

Purpose
The aim of the study was to investigate visual outcome in patients with traumatic cataract after cataract surgery and to study the various etiological factors.
Patients and methods
A prospective study was carried out on all patients with traumatic cataract who underwent cataract extraction with primary intraocular lens implantation at a tertiary eye hospital between January 2012 and December 2014. Data were collected on age, sex, preoperative vision, postoperative vision at 3–6 months, and postoperative complications responsible for decreased visual acuity.
Results
Fifty eyes in 50 patients were studied. The study population comprised 36 male and 14 female patients. The preoperative visual acuity was less than 6/60 in all 50 eyes. The postoperative visual acuity in 28 eyes was 6/6–6/12, whereas 20 eyes had visual acuity of 6/18–6/36 and two eyes had visual acuity less than 6/60. The cause of poor visual acuity was mainly corneal opacity and posterior capsular opacity.
Conclusion
Our study shows that good visual results can be achieved with traumatic cataract surgery if the posterior segment is not involved and the corneal scar does not block the optical axis.

Keywords: ocular trauma, posterior capsular defects, posterior capsular opacification, traumatic cataract, visual outcome


How to cite this article:
Bhandari AJ, Jorvekar SA, Singh P, Bangal SV. Outcome after cataract surgery in patients with traumatic cataract. Delta J Ophthalmol 2016;17:56-8

How to cite this URL:
Bhandari AJ, Jorvekar SA, Singh P, Bangal SV. Outcome after cataract surgery in patients with traumatic cataract. Delta J Ophthalmol [serial online] 2016 [cited 2017 Oct 20];17:56-8. Available from: http://www.djo.eg.net/text.asp?2016/17/2/56/189074


  Introduction Top


Ocular trauma is the leading cause of unilateral blindness in children worldwide [1]. Traumatic cataract is a common sequelae of ocular injuries in adults and children [2],[3]. The incidence of ocular injuries varies across the world. In India, the reported incidence is 20.53% [4]. Management of traumatic cataract that results from either blunt or penetrating ocular trauma needs special consideration because of associated injury to ocular and periorbital structures. Children and young adults, especially boys, are more predisposed to trauma and have a higher incidence of traumatic cataract [5]. The timing of surgery is important for visual rehabilitation, especially in children, as the risk for amblyopia is high because of media opacity. Several studies have revealed that early cataract extraction with intraocular lens (IOL) implantation in patients with traumatic cataract results in good vision [6].

This study was carried out to assess the visual rehabilitation that can be achieved following early cataract extraction and IOL implantation in traumatic cataract cases.


  Patients and methods Top


This was a prospective study. All patients with traumatic cataract who underwent cataract extraction with primary IOL implantation at a tertiary eye hospital in western Maharashtra between January 2012 and December 2014 were included. As the outcome of cataract surgery in trauma is dependent upon the time interval between the occurrence of trauma and operation, all cases had been operated upon for cataract surgery as soon as possible after the inflammation had subsided. In our study all cases with only traumatic cataract were operated upon for cataract within 2 days of presentation, and those with corneal tear were primarily managed by corneal tear suturing. In our study all cases were above 5 years of age, and thus anterior vitrectomy was not performed along with cataract surgery in any of the cases. In two cases, those below 6 years of age underwent posterior capsulotomy during cataract surgery. Our main outcome measure was visual acuity at 3 and 6 months, assessed using Snellen’s chart. Patients’ data including demographic details, causative agents, initial visual acuity, intraocular pressure, slit-lamp examination findings, B-scan findings, surgery, early and late complications, and final outcomes were obtained from hospital charts. Patients were subsequently followed up at 1 day, 1 week, 6 weeks, 3 months, and 6 months postoperatively. At each follow-up visit the patients’ visual acuity was recorded. Final best-corrected visual acuity was recorded on the fifth postoperative visit – that is, at 6 months. Ethical clearance was taken from Ethics committee of institute and written informed consent was taken from all the patients.


  Results Top


A total of 50 eyes of 50 patients were included in the study. The majority of patients were men and were aged 35 years or younger [Table 1].
Table 1 Age distribution of cases

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Out of a total 50 traumatic cataract patients, 30 (60%) were male and 20 (40%) were female, with a male to female ratio of 1.5 : 1 ([Graph 1]).



All eyes had poor vision at presentation [Table 2]. Preoperative findings included peripheral corneal perforation in 18 eyes, central corneal perforation in six eyes, irregular pupil in 15 eyes, and posterior synechiae in five eyes. All cases (24) with corneal tear were primarily managed by corneal tear suturing on the same day of presentation.
Table 2 Visual acuity at presentation

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Six months after surgery, visual acuity was 6/6–6/12 in 28 eyes, 6/18–6/60 in 20 eyes, and less than 6/60 in two eyes [Table 3].
Table 3 Postoperative visual acuity

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The cause of less visual acuity was mainly central corneal opacity in six cases and posterior capsular opacity in 12 cases. All cases (12) with posterior capsular opacity were managed with yttrium aluminium garnett (YAG) capsulotomy, which resulted in improvement in vision (6/6–6/12). Ten cases developed posterior synechiae in the early postoperative period. By keeping the pupil mobile with mydriatics and increasing the dose of topical corticosteroid eyedrops the synechiae was broken. Seven cases developed posterior synechiae and did not respond to pupil dilation or corticosteroid eyedrops. However, these synechiae did not affect the vision and thus no intervention was carried out. Three cases developed clinical cystoid macular edema. In these cases the visual acuity improved to 6/12 after subsidence of macular edema.


  Discussion Top


This study included 50 cases of traumatic cataract managed at the Department of Ophthalmology, at tertiary eye hospital in western Maharashtra. Traumatic cataract is one of the most common outcomes of ocular injuries. There is a 1–15% incidence of traumatic cataract in ocular injuries [7]. Trauma is the leading cause of 90% of acquired pediatric cataracts [8]. In this study, male preponderance was found, with a male to female ratio of 1.5 : 1. This is due to the involvement of boys in sports and outdoor activities. Worldwide, traumatic cataract is more commonly found in the male population than in the female population [9]. Zaman et al. [10] stated that the majority (50.64%) of traumatic cataract patients ranged in age from 5 to 15 years, which is consistent with the present findings – that is, 42% of cases ranged in age between 5 and 25 years. Sports and work-related eye injuries most commonly occur in children and young adults, followed by injuries related to accidents, because of involvement of children in high-risk sports without supervision or without adopting protective measures [10]. In our study no case had developed amblyopia as amblyopia treatment had started early in the postoperative period for all pediatric cases and young adults. Penetrating injuries are the most common cause of ocular injuries [11]; the same was observed in this study. Twenty-eight (56%) patients sustained penetrating injuries, whereas 22 (44%) patients presented with blunt injury. Implantation of IOL in traumatized eyes after removal of traumatic cataract depends on the availability of capsular support. Capsular bag or sulcus fixation is preferred if there is sufficient capsular and zonular support. The majority of these patients were operated upon within 6 months after trauma. The duration between injury and cataract surgery was less than 1 month in 17 (34%) patients, 1–6 months in 16 (32%) patients, 7–12 months in seven (14%) patients, and more than 12 months in 10 (20%) patients. The major postoperative complication encountered on the first postoperative day was severe uveitis (48%), which responded to medical therapy. Cheema and Lukran [12] reported that fibrinous uveitis was the most common postoperative complication (25%). It may be mainly due to surgical trauma in an already traumatized eye and not related to type or location of the IOL inside the eye. This study revealed that satisfactory visual outcome in the majority of patients with traumatic cataract could be safely achieved after cataract removal and IOL implantation. Best-corrected visual acuity was 6/6–6/9 in 20 (48.8%) patients and 6/18 or better in 29 (70.8%) patients. Zaman et al. [10] and Cheema and Lukran [12] reported visual acuity of 6/18 or better in 68.7% of patients [Table 4].
Table 4 Postoperative complications encountered in the present study

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The main reasons for the lack of improvement in visual acuity in the patients in this study were corneal opacity and high astigmatism. Blindness from ocular trauma can be avoided by using protective eyewear, especially when undertaking high-risk activities. Educational programmes must be carried out in schools and child daycare centers as well as through media to prevent ocular injuries in children. Once the injury has occurred, outcome depends on the extent of injury to the ocular and periorbital structures, and immediate and professional approach must be taken to prevent blindness.


  Conclusion Top


Good postoperative visual acuity can be achieved from traumatic cataract surgery due to blunt or penetrating injury if the posterior segment is not involved and the corneal scar does not block vision. Taking protective measures in sports and work and patient education can avoid ocular trauma and traumatic cataract formation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Blum M, Tetz MR, Greiner C, Voelcker HE Treatment of traumatic cataracts. J Cataract Refract Surg 1996; 22:342-346.  Back to cited text no. 1
    
2.
Mian ST, Azar DT, Colby K. Management of traumatic cataracts. Int Ophthalmol Clin 2002; 42:23-31.  Back to cited text no. 2
    
3.
Thakker MM, Ray S. Vision limiting complications in open glob injuries. Can J Ophthalmol 2006; 41:86-92.  Back to cited text no. 3
    
4.
Bhatia IM, Panda A, Dayal Y. Role of ultrasonography in ocular trauma. Indian J Ophthalmol 1983; 31:495-498.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Coody D, Banks JM, Yetman RJ, Musgrove K. Eye trauma in children: epidemiology, management, and prevention. J Pediatr Health Care 1997;11:182-188.  Back to cited text no. 5
    
6.
Bekibele CO, Fasina O. Visual outcome of traumatic cataract surgery in Ibadan, Nigeria. Niger J Clin Pract 2008; 11:372-375.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Cohen, A, Peter S, Hershand JA, Fleishman R. Management of trauma induced cataract. Optm Clin North Am 1995; 8:633-646.  Back to cited text no. 7
    
8.
Perucho-Martínez S, De-la-Cruz-Bertolo J, Tejada-Palacios P. Paediatric cataracts: epidemiology and diagnosis. Retrospective review of 79 cases. Arch Soc Esp Oftalmol 2007; 82:37-42.  Back to cited text no. 8
    
9.
Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Aetiology of childhood cataract in south India. Br J Ophthalmol 1996; 80:628-632.  Back to cited text no. 9
    
10.
Zaman M, Sofia I, Muhammad DK. Frequency and visual outcome of traumatic cataract. J Postgrad Med Inst 2006; 20:330-334.  Back to cited text no. 10
    
11.
Grieshaber MC, Stegmann R. Penetrating eye injuries in South African children: aetiology and visual outcome. Eye (Lond) 2006; 20:789-795.  Back to cited text no. 11
    
12.
Cheema RA, Lukran AD. Visual recovery in unilateral traumatic paediatric cataracts related with posterior chamber intraocular lens and anterior vitrectomy in Pakistan. Int Ophthalmol 1999;23:85-89.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Patients and methods
Results
Discussion
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