Refractive and visual outcomes after surgery for pediatric traumatic cataract

Abstract

To describe refractive and visual outcomes of pediatric traumatic cataract requiring surgery and evaluate the factors influencing success. Hospital for Sick Children, Toronto, Ontario, Canada. Retrospective case series. 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. One hundred six children (mean age 7.6years±3.9 [SD]) were included. The median follow-up was 41months (range 3 to 155months). 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 10.4years; 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 5years was associated with worse refractive outcomes (OR, 2.88; P=.02). 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.