Surgical intervention for traumatic cataracts in children: Epidemiology, complications, and outcomes

Pediatric traumatic cataracts: 10-year experience of a tertiary referral center

Background

This study aimed to evaluate the factors influencing final visual acuity in pediatric traumatic cataracts.

Methods

Data of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated age at trauma; gender, trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final best corrected visual acuity (BCVA); amblyopia rate; and complications.

Results

In all, 61 eyes of 59 patients aged < 16 years with cataracts after trauma were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The BCVA was 0.7 LogMAR or better in 5.9% of the 49 eyes in which the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. Evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final visual acuity compared with eyes that did not undergo these procedures.

Conclusions

In children with posttraumatic cataracts, final visual acuity was not affected by patient age and gender; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; and time, location, and type of intraocular lens (IOL) implantation. Improvements in the final BCVA could be seen only by PC + AV combined with lens aspiration with or without IOL implantation. However, this approach of amblyopia treatment needs to be confirmed by more comprehensive and prospective studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02427-6.

Outcome of Pediatric Traumatic Cataract in Upper Egypt: A Tertiary Center Study

Purpose

To demonstrate the demographic features, causative agents, and outcome of pediatric traumatic cataract surgery in eyes without posterior segment involvement at Assiut University Hospital, Upper Egypt.

Patients and Methods

This is a retrospective study on children (aged <18 years old) who underwent traumatic cataract surgery from January to June 2019. Children with posterior segment injury and those who did not complete 6 months of postoperative follow-up were excluded. The demographic features, mechanism and time of eye injury, clinical features, surgical approach, and outcome were recorded and analyzed.

Results

The study included 34 eyes of 34 children, 23 (68%) of them were boys. The mean age at the time of cataract surgery was 10±3.97 years. Twenty-one eyes sustained open globe injury (62%) with the most common cause of trauma was wooden sticks, while 13 eyes had closed globe injury (38%) with the most common cause of injury was thrown stones. The time interval between eye injury and cataract surgery ranged from 1 day to 9 years with a median of 2.05 months. Posterior chamber intraocular lenses were implanted in all eyes; in 33 eyes, the posterior chamber intraocular lenses were implanted primarily at the time of cataract extraction. Corrected distance visual acuity significantly improved from 2.63±0.66 LogMAR preoperatively, to 0.41±0.38 LogMAR postoperatively (p < 0.001).

Conclusion

Pediatric traumatic cataract is commonly present in primary school age especially after open globe injury. Primary prevention through health awareness should target this age population. Useful vision can be regained with timely proper surgical intervention and posterior chamber intraocular lens implantation.

Clinicaltrials.gov Id

NCT04630509.

Lamellar Dissection Technique for Traumatic Cataract With Corneal Incarceration

PURPOSE

To describe a technique for traumatic cataract management for cases in which part of the anterior capsule has been incarcerated into a healed corneal laceration.

METHODS

This is a single-center retrospective chart review of 3 patients with capsular/corneal incarceration after penetrating injury. Each patient underwent primary globe repair, followed by subsequent cataract surgery with intraocular lens (IOL) and iris prosthesis placement. The main outcome measure was corrected distance visual acuity.

RESULTS

At a mean of 19-month postoperative follow-up (range 12-26 mo), corrected distance visual acuity ranged from 20/25 to 20/80 and all patients had improved vision compared with before cataract surgery. At the final follow-up, all IOLs and iris prostheses were in stable position and no eyes required corneal transplantation.

CONCLUSIONS

Traumatic cataracts may be complicated by incarceration of the anterior capsule into the cornea. Incorporating the posterior aspect of the cornea into the anterior capsulotomy enables cataract removal and IOL placement in a stable capsular bag complex.

Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery

BACKGROUND AND OBJECTIVES

This study aimed to investigate the impact of the possible prognostic factors for postsurgical success on visual acuity (VA) in traumatic cataract patients.

MATERIALS AND METHODS

The files of 92 patients (19 women[20.6%]-73 men[79.4%], 44 right-48 left total 92 eyes) who underwent surgery for traumatic cataracts between 2004 and 2018 were retrospectively reviewed for preoperative and final corrected distance VA(CDVA), laterality of trauma, time of admission to a hospital after trauma(TAH), type of injury, location of the injury (zone 1 [corneal], zone 2 [corneal and scleral], zone 3 [scleral]), additional ocular injury, simultaneous or secondary surgery, surgical cataract techniques, and complications.

RESULT

Of the 92 patients enrolled in the study, the mean CDVA was improved from preoperative 1.95 ± 0.49 logMAR to postoperative 0.73 ± 0.72 logMAR.(p < 0.001) In 36.7% of cases, the final CDVA was ≥ 20/40; it was ≥ 20/60 in 58.7%, ≥ 20/200 in 73.9%, and ≥ 20/400 in 94.5%. The strongest correlation was found between postoperative CDVA and preoperative CDVA (Pearson's R = 0.969, p = 0.0001). No correlation was found between CDVA and age, sex, and laterality. The regression analysis showed a significant relationship between the increase in CDVA and TAH, trauma type and location, and surgical timing and techniques. The worst CDVA prognosis was found for patients with a zone 3 injury; patients with a zone 1 injury had the best prognosis. The prognosis is better for a closed globe injury than an open globe injury (p = 0.019). Early TAH was related to a better prognosis than later admissions. No difference was observed between simultaneous and secondary surgeries (p = 0.413) and surgical techniques (p = 0.12).

CONCLUSION

Postoperative CDVA is better in traumatic cataract patients with a better preoperative VA. Early hospital admission after trauma, closed globe, and zone 1 injuries are better prognostic factors than late hospital admission time, open globe, and zone 3 injuries.

Refractive and visual outcomes after surgery for pediatric traumatic cataract

PURPOSE

To describe refractive and visual outcomes of pediatric traumatic cataract requiring surgery and evaluate the factors influencing success.

SETTING

Hospital for Sick Children, Toronto, Ontario, Canada.

DESIGN

Retrospective case series.

METHODS

Charts of children having lensectomy for traumatic cataract between January 1, 2000, and June 30, 2015, were reviewed for demographic information, visual and refractive outcomes, complications, and surgical details.

RESULTS

One hundred six children (mean age 7.6 years ± 3.9 [SD]) were included. The median follow-up was 41 months (range 3 to 155 months). Seventy-nine children had open-globe injuries and 27 had closed-globe injuries. Patients with open-globe injuries were younger than those with closed-globe injuries (mean age 6.9 versus 10.4 years; P < .05). The final corrected distance visual acuity (CDVA) was 20/40 or better in 47 children. In the 94 children who had intraocular lens placement, 54% with open-globe injuries and 55% with closed-globe injuries achieved a mean absolute prediction error of 1.0 diopter or less in the early postoperative period. Open-globe injuries and amblyopia were associated with worse visual outcomes (odds ratio [OR], 2.8 and P = .03 versus OR, 2.4 and P = .04) and refractive outcomes (OR, 3.1 and P = .02 versus OR, 3.8 and P = .04). Age younger than 5 years was associated with worse refractive outcomes (OR, 2.88; P = .02).

CONCLUSIONS

Children requiring surgery for traumatic cataract can have good visual and refractive outcomes. Those with open-globe and those with closed-globe injuries both had good early postoperative refractive accuracy. Sixty-three percent of children with closed-globe injuries attained a CDVA of 20/40 or better at the final follow-up.

Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma

PURPOSE

To evaluate the visual and refractive outcomes in children 8 years of age or younger with corneal laceration and cataract following penetrating ocular injuries who underwent primary corneal tear repair followed within 1 to 8 weeks by early secondary cataract extraction.

METHODS

This retrospective, non-comparative case series reviewed the admission and operative charts of children 8 years of age or younger (range: 3 to 8 years) who underwent corneal wound repair as the primary surgical procedure followed within 1 to 8 weeks by cataract extraction with intraocular lens implantation, with a minimum follow-up period of 6 months. The main outcome measures were best corrected visual acuity (BCVA) and refractive error as the spherical equivalent at the final follow-up visit.

RESULTS

A total of 47 children (33 boys, 14 girls) were included. The mean age at the time of injury was 5.9 ± 2.2 years (range: 3 to 8 years). Follow-up periods ranged from 6 months to 3 years (median: 18 months). The mean time gap between the wound repair and cataract extraction was 5 weeks (range: 1 to 8 weeks). Approximately 36 (77%) eyes obtained BCVA better than 6/18. All but one eye achieved BCVA better than 6/60. The deviation from emmetropia was less than 1.00 diopter (D) in 23 (54%) eyes, 1.00 to 3.00 D in 15 (35%) eyes, and more than 3.00 D in 5 (12%) eyes.

CONCLUSIONS

Early removal of cataract with intraocular lens implantation 1 to 8 weeks after the primary wound repair in young children with penetrating corneal injuries can result in excellent visual and refractive outcomes with early intervention and aggressive amblyopia treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(2):122-127.].

Visual Outcome of Traumatic Cataract at a Tertiary Eye Care Centre in North India: A Prospective Study

INTRODUCTION

One of the most common presentations of blunt and penetrating ocular trauma is traumatic cataract. It remains a significant cause of visual impairment and physical disability among adults and children. It is associated with various ocular injuries.

AIM

To evaluate the associated ocular injuries and final outcome of patients with traumatic cataract along with their demographic features and modes of trauma.

MATERIALS AND METHODS

A prospective study done in Department of Ophthalmology in M.L.B. Medical college, Jhansi from February 2010 to July 2011. A total of 48 patients diagnosed as a case of traumatic cataract were subjected to a detailed history, systemic and local examination with relevant investigations. Medical or surgical managements were done accordingly. Patients were subsequently followed-up and visual acuity was recorded. Appropriate statistical tests were applied.

RESULTS

A 54.2% patients sustained penetrating trauma while 45.8% got blunt injury. Out of total, 79% patients were males while 50% were less than 15 years of age. Causative agents were stone, wood items, stick, metal objects etc. Among blunt trauma cases, 64% of the patients had visual acuity <6/60 while among penetrating trauma cases nobody had acuity >6/18. Anterior segment was more involved as compared to posterior segment. A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of >6/18.

CONCLUSION

This study provides recent data of patients hospitalized after ocular trauma and diagnosed as a case of traumatic cataract. Traumatic cataract occurs mostly in younger males. Surgical intervention is necessary to improve visual outcome. Good visual outcome was obtained in nearly half of the patients. Traumatic cataract patients can have good visual outcome depending upon proper management.

Unilateral Congenital and Developmental Cataracts in Children in India: How Useful Were Long-Term Outcomes of Surgery? Miraj Pediatric Cataract Study 4

PURPOSE

To study visual outcomes and stereopsis after a 3-8 year follow-up in unilateral congenital and developmental cataracts.

DESIGN

Clinical case series.

METHODS

Children who underwent surgery for unilateral pediatric cataract from 2004 to 2008 were traced and reexamined prospectively from 2010 to 2011. Demographic and clinical factors were noted from their retrospective chart readings. All children underwent visual acuity assessment and comprehensive ocular examinations including stereoacuity in a standardized manner during the prospective follow-up visits. Details of amblyopia management were recorded for univariate and multivariate analyses.

RESULTS

Forty-eight eyes of 48 children had a mean follow-up of 4.4 years between surgery and assessment (SD, 1.6 years). Twenty-four (50%) were boys, and the average age at surgery was 10.2 years (SD, 4.1). Two (4.2%) were congenital, 14 (29.2%) developmental, and 32 (66.7%) congenital/developmental cataracts. Preoperatively, 38 (79.2%) had vision less than 3/60. After surgery, 12 (25%) had improved best-corrected visual acuity (BCVA) of 6/18 or greater, 4 (8.3%) had BCVA of 6/24 to 6/60, and 32 (66.7%) had BCVA of less than 6/60. Eleven (22.9%) had binocular single vision 480 seconds or less of arc on Titmus test. Preoperative vision (P = 0.034) was significantly associated with postoperative visual outcomes, but not age at surgery (P = 0.14), sex (P = 0.897), type of surgery (P = 0.371), or type of intraocular lens (P = 0.66). The use of phacoemulsification was associated with better vision, but it was not significant (P = 0.069).

CONCLUSIONS

Long-term visual outcomes in unilateral pediatric cataracts were subnormal due to deprivation amblyopia, but vision improved over preoperative levels and helped in binocular stereoacuity. Some preoperative vision was associated with better visual outcomes.

Posterior capsule opacification in pediatric eyes with and without traumatic cataract

PURPOSE

To compare the rate of visually significant posterior capsule opacification (PCO) in pediatric eyes with and without traumatic cataract.

SETTING

Storm Eye Institute, Charleston, South Carolina, USA.

DESIGN

Retrospective case control study.

METHODS

Eyes operated on for traumatic cataract and having in-the-bag single-piece hydrophobic intraocular lens (IOL) implantation were identified. The control group of eyes operated on for nontraumatic cataract was matched with reference to age, management of the posterior capsule, type of IOL, and follow-up duration.

RESULTS

Data from 58 eyes were studied. Age at surgery was comparable between the study group and the control group (7.3 versus 7.8 years) (P = .7). The rate of PCO was statistically significantly different between the 2 groups (12/29 eyes versus 2/29 eyes) (P = .002). This difference was more marked for those with intact posterior capsules (9/12 eyes [75%] and 1/12 eyes [8%] (P = .001) compared with eyes with primary posterior capsulectomy and vitrectomy (3/17 [18%] and 1/17 [6%] (P = .6). For eyes with intact posterior capsules, the duration between cataract surgery and intervention for PCO was 4 to 15 months in the traumatic cataract group; 1 eye in the nontraumatic cataract group required intervention 20 months after surgery.

CONCLUSIONS

Eyes with traumatic cataract were more likely to develop PCO than eyes without traumatic cataract. The results also suggest that PCO develops faster in eyes with traumatic cataract. Primary posterior capsulectomy and vitrectomy should be considered for children having traumatic cataract surgery, irrespective of age at the time of surgery.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Complications of pediatric cataract surgery

PURPOSE

Cataract surgery in young children poses different challenges and potential complications compared to those encountered in adult populations. We performed a literature review of the complications of pediatric cataract surgery.

METHODS

Literature review of complications of pediatric cataract surgery.

RESULTS

Complications in children vary based on the age of the patient at surgery and the cause of the cataract. Common events discussed include increased inflammatory response, opacification of the posterior capsule, lens reproliferation, pupillary membrane, and amblyopia; less common events include infections, significant bleeding, and retinal detachment.

CONCLUSION

Complications after cataract surgery in children are often associated with a robust inflammatory reaction or secondary opacity and, in infants, glaucoma. Late complications can occur decades later, so that long-term follow-up is required. Though surgery carries significant risks, the consequences of no surgery and irreversible deprivation amblyopia in very young children should be considered.

Epidemiology and Intermediate-Term Outcomes of Open- and Closed-Globe Injuries in Traumatic Childhood Cataract

Purpose

To study epidemiology and intermediate-term outcomes of open- and closed-globe injuries (CGI) in traumatic childhood cataract.

Methods

In this retrospective interventional case series, demographic parameters and history including type of injury of 57 children younger than 16 years with traumatic cataract were recorded; ocular examination included best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, and posterior segment evaluation. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Main surgical outcomes at 6 months comprised BCVA, residual refractive spherical error (SE), and postoperative complications, namely visual axis opacification (VAO) and amblyopia.

Results

Bow and arrow was the most common causal agent. Open-globe injury (OGI) was 3 times more frequent than CGI. There was a significant visual gain from baseline in both groups after cataract surgery (p<0.001); residual SE was greater in OGI (1.6 ± 0.95 SD) compared to blunt trauma (0.8 ± 0.55 SD; p = 0.001). Incidence of corneal scarring, iris distortion, posterior synechiae, and intraoperative posterior capsular tear was greater with OGI (p<0.05). A total of 86% of patients were rehabilitated with a primary/secondary IOL. Single-piece IOL implantation rate (p = 0.004) was significantly greater in CGI, with no statistical difference for in-the-bag IOL (p = 0.053) and IOL implantation rate (p = 0.16). Final BCVA was significantly better for in-the-bag IOL implantation compared to sulcus fixation. Postoperative complications included amblyopia (51%) and VAO (12%).

Conclusions

Bow and arrow injury caused the maximum cases of traumatic cataract; cataract extraction resulted in significant visual improvement; and CGI tended to have better prognosis in pediatric traumatic cataracts.

Pediatric traumatic cataract and surgery outcomes in eastern China: a hospital-based study

AIM

To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China.

METHODS

Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis.

RESULTS

A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included in the study. The mean (SEM) age at diagnosis was (6.6±3.2) years (range, 1.3-13.8 years). Each cataract was categorized according to the type of trauma: closed-globe (n=26) or open-globe (n=91) injuries. The most common injuring objects were sharp metal objects (37.61%). The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs) were primarily implanted in 47 eyes (68.12%), whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%). The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision.

CONCLUSION

Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.

Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India

Purpose:

To describe preoperative factors, long-term (>3 years) postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India.

Subjects:

Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center.

Materials and Methods:

Traumatic cataracts operated in 2004–2008 were reexamined prospectively in 2010–2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded.

Statistical Analysis:

Data analysis done by using SPSS (Statistical package for social sciences) version 17.0 We have used Chi-square test, Fisher's exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60.

Results:

The children were examined in a 3–7 year follow-up (4.35 ± 1.54). Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18). Fifty (61.7%) were boys. Forty (48.8%) were blunt and 32 (39%) were sharp trauma. The most common cause was wooden stick 23 (28.0%) and sharp thorn 14 (17.1%). Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001). Thirty-eight (46.3%) had best corrected visual acuity (BCVA) ≥6/18 and 51 (62.2%) had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18) depended on type of surgery (P = 0.002), gender (P = 0.028), and type of injury (P = 0.07)–sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22%) needed more than one surgery. The parents spent an average of 2250 ($45) for the surgery and 55 (66.4%) were from lower socio-economic class.

Conclusion:

The postoperative visual outcomes varied and less than half achieved ≥ 6/18.

Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India

BACKGROUND

We studied the demographic profile and outcome of traumatic cataract after penetrating and blunt ocular trauma in children in northern India.

METHODS

We reviewed the medical records of children with penetrating and blunt ocular trauma associated with traumatic cataract who underwent cataract surgery with posterior chamber intraocular lens implantation and having more than 1 year follow up. We evaluated the demographic characteristics and visual outcome in the affected eye.

RESULTS

Of the 100 children (100 eyes), 65 were penetrating trauma and 35 were blunt trauma. The common modes of injury in the penetrating group were wooden splinters in 30.8% and bow and arrow in 15.4%. Fire crackers and trauma during play with ball were seen in 34% and 11.4% of blunt eye trauma, respectively. The age ranged from 1 to 14 years (mean, 7.8 years) in the penetrating trauma and 2 to 15 years (mean, 8.3 years) in the blunt trauma group. The best corrected visual acuity of 20/40 or better was achieved in 57.6% eyes in penetrating group compared with 71.4% in the blunt trauma group. Visually significant posterior capsular opacification developed in 32.3% eyes in penetrating group and 28.6% eyes in blunt trauma group. Glaucoma was diagnosed in 4.6% eyes in penetrating group and 8.6% in blunt trauma group.

CONCLUSION

Eye injuries with traumatic cataract are associated with significant visual impairment. There were more children with penetrating eye injuries as compared with blunt trauma. Cataract surgery with intraocular lens implantation is a preferred method for visual rehabilitation in these children.

LEVEL OF EVIDENCE

Epidemiologic study, level IV.

Anesthesia for a thoracic BB gun injury

Pediatric anesthesiologists care for children with penetrating trauma from nonpowder (BB and pellet) guns. We present the case of a 9-year-old boy who required urgent median sternotomy for cardiac tamponade after sustaining a close-range BB gun injury to the chest. After summarizing the epidemiology of nonpowder gun injuries in children, we clarify the nomenclature, ballistics, and mechanisms of these guns, discuss the tendency to minimize these kinds of injuries, explain bullet embolization, and review (by body area) current clinical management issues.