Management Of Traumatic Cataract Research Articles

Controversies regarding the classification and management of traumatic cataract in the paediatric age group: a review

Controversies regarding the classification and management of traumatic cataract in the paediatric age group: a review

Clinical Outcomes of Management of Traumatic Cataract in a Tertiary Care Centre

Background and Objectives : Ocular trauma can lead to development of cataract when natural lens is damaged by either blunt or penetrating injury. The management of traumatic cataract follows the same principle as for senile cataract but associated damage to ocular tissues and several post-operative complications may lead to suboptimal visual outcome. This study was conceptualized to evaluate the visual outcomes following management of traumatic cataracts. Material and Methods : This prospective, longitudinal study was conducted on 80 patients with traumatic cataract in tertiary care centre. Patients were managed surgically and were followed up for a period of six months. Visual acuity was measured at every follow-up visit and any post-operative complications were noted and managed, accordingly. Final visual acuity was assessed at the end of six months. Results: Maximum cases of traumatic cataract (53.75%) were observed in age group of <20 years with male to female ratio of 2.63:1. Maximum patients (92.15%) were implanted posterior chamber intraocular lens, either as a primary or secondary procedure. Uveitis and posterior capsular opacification were most common post-operative complications (30%) and 68.75% cases achieved a final visual acuity of 6/6-6/ 18 at the end of six months. Conclusions Traumatic cataract is an important cause of ocular morbidity specially in young patients. Surgery in cases of traumatic cataract can yield good visual outcomes if posterior segment is not involved and if post-operative complications are managed efficiently.

A prospective clinical evaluation and management of traumatic cataract

Aim: The aim was to present the experience in the management of cases of traumatic cataract with special reference to age, sex, type of injury, preoperative status of the eye, associated ocular injury, timing of injury and its effect on the final visual outcome. Design: Prospective study. Statistical Analysis: Non-parametric method (Mann whitney U test).

Surgical Outcome of Traumatic Cataract Following Corneal Perforation in Children in a Tertiary Eye Care Centre in Nepal

Introduction: Traumatic paediatric cataract is challenging and its management is difficult. It is associated with other distortion of ocular anatomy and subsequent post- operative complication poses more problems. It is mostly unilateral. The purpose of this study is to assess the outcome of traumatic cataract following corneal perforation in Nepalese children in a tertiary eye hospital in Nepal.Material and Methods: It was a retrospective review of medical records of children who developed cataract following perforating corneal injuries. The study included 69 cases diagnosed as unilateral traumatic cataract over a period of 70 months (January 2010 till October 2015) at Tilganga Institute of Ophthalmology (TIO). Traumatic cataracts caused by other than the perforating corneal injuries were excluded from the study.Results: Children between 6 to 10 years of age had highest percentage of ocular trauma. Boys were more commonly affected than girls. Forty two percentages of children had visual outcome of better than or equal to 6/18.Poor visual outcome was mainly due to anterior segment pathology- corneal scar (14.49%).Posterior segment pathology like macular scar, vitreous haemorrhage and retinal detachment contributed to 7.34% of the cause.Conclusion: Outcome of the traumatic cataract surgery varied. Visual outcome of post traumatic cataract after corneal perforation was dependent on multiple factors like co- existence of the anterior and posterior segment trauma, per –operative and post-operative challenges. Prompt and good management of traumatic cataract can result in good visual outcome.J Nepal Paediatr Soc 2016;36(1):50-55

Dry phacoemulsification system for traumatic cataract with capsule rupture

Objective To investigate the efficacy and safety of dry phacoemulsification system in the management of traumatic cataract with capsule rupture.Methods Retrospective study.33 eyes of 33 patients who underwent dry phacoemulsification and IOL implantation for traumatic cataract with capsule rupture were enrolled in this study.The follow-up period was 3-6 months.The best corrected visual acuity (BCVA),intraocular pressure,and postoperative complications were observed.Results No intraoperative complications occurred during surgery.All the IOL were implanted primarily.The final BCVA was 0.8-1.0 in 8 eyes of 33 eyes (24.24％),0.3-0.7 in 21 eyes (63.64％),0.05-0.25 in 3 eyes (9.10％) and 0.02 in 1 eye (3.03％).Conclusion Dry phacoemulsification system is safe and effective for traumatic cataract with capsule rupture. Key words: Cataract,traumatic; Rupture,capsule; Phacoemulsification

Visual recovery after managing traumatic cataracts

Dear Editor, We read with interest the article on, ‘Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients’ by Shah et al.[1] There are few points on which we would like some clarifications, based on the data provided in the manuscript. Recruitment of subjects Authors have described high frequency of penetrating injuries in their study. However, the exclusion of patients with closed injuries associated with retinal detachment and secondary glaucoma implies an obvious bias and explains the high frequency of penetrating injuries seen in the cohort. Classification of cataract While classifying traumatic cataracts, it is not clear how cataracts with anterior capsular tear and localized cortical opacification in the visual axis but without loose cortical matter in anterior chamber were classified and whether such eyes were included in the study cohort. Cataract surgery The manuscript states that in all cases of corneal wound repair, traumatic cataract was managed as a second procedure. We would like to know how eyes with anterior capsular rupture with flocculent lens matter in anterior chamber managed. It would be pertinent for the authors to describe their technique of surgical management of cataract and anterior vitrectomy. Also it is not clearly understood whether capsulectomy and vitrectomy were performed in all adults only to overcome the significant vitreous haze. The manuscript makes no mention of zonular dialysis and subluxated cataract, which is a common associated pathology in cases of ocular trauma.[2] Follow-up A six weeks follow-up is inadequate to comment on the long-term complications of ocular trauma or to assess advent of amblyopia in children under seven years. Injuries to other ocular structures It is not clearly understood what the authors imply as ‘Missing’ in Table 4.[1] Also it is difficult to believe that none of the 555 patients developed any traumatic optic neuropathy. On the contrary, the presence of an afferent pupillary defect has been described as an indicator of poor visual outcome in cases with traumatic cataract.[3] Reason for failure in improvement in vision No reason for failure of improvement in visual acuity was noted in 202 (36.4%) patients, which is more than one-third of the study cohort. How do the authors explain this unusual observation in their study? Also what were included in the other causes noted in seven patients in the study? Conclusion Without taking into consideration the posterior segment complications, concluding that open globe injury has a favorable prognosis for satisfactory visual recovery after the management of traumatic cataract is too simplistic and sends out an incorrect message to the readers.

Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract

The objective of this work is to compare final visual outcomes in cases of surgically treated traumatic cataract between open-globe and closed-globe groups, as classified by the Birmingham Eye Trauma Terminology system. Observational cohort study. Tertiary eye-care center at the trijunction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. We enrolled patients meeting specific inclusion criteria, examined their eyes to review any co-morbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were re-examined 6weeks postoperatively. We classified the cases of traumatic cataract as either open-globe (group 1) or closed-globe (group 2), according to the Birmingham Eye Trauma Terminology (BETT) system, and compared visual acuity. Visual Acuity. Our cohort of 687 eyes with traumatic cataracts included 496 eyes in group 1 and 191 in group 2. Six weeks postoperatively, the visual acuity was >20/60 in 298 (58%) and 75 (39.1%) operated eyes in groups 1 and 2, respectively (p < 0.001, ANOVA). At follow-up, >20/60 vision was significantly higher in group 1 than in group 2 (OR = 1.61; 95% CI, 0.85-3.02). Overall, 373 eyes (54.3%) regained final visual acuity >20/60. Open-globe injury has a more favorable prognosis for satisfactory (>20/60) visual recovery after management of traumatic cataracts.

Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients

Aim:The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis.Materials and Methods:This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the “open globe” (Group 1) and “closed globe” (Group 2) groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS) and compared the determinants of visual acuity.Results:Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48%) and 49 (29%) eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA). At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85–3.02). Overall 242 (43.5%) eyes gained a final visual acuity of >20/60.Conclusion:Open globe injury has a favorable prognosis for satisfactory (>20/60) visual recovery after the management of traumatic cataracts.

Systematic approach to pediatric ocular trauma

The aim of this article is to evaluate and review the scientific literature on pediatric ocular trauma from the past several years. Recent advancements have recognized mechanisms of injury that may be unique to children, require different treatment course than adults, and raise multiple public health concerns. Epidemiologic studies have shown that ocular trauma is a major cause of monocular blindness and potential disability in children worldwide. The mechanisms of injury are quite variable and often found under mundane circumstances. Orbital fractures in children are more likely to cause entrapment of orbital contents due to the structure of orbital bones at an early age and require earlier surgical repair. The management of traumatic hyphema responds well to outpatient care and topical aminocaproic acid. The management of traumatic cataracts has been enhanced with new iris-fixated lens implants. Endophthalmitis after ocular trauma carries a significantly worse prognosis, which may be reduced by early referral and intervention. This review broadens our understanding of the mechanisms, treatment, and prognostic indicators in pediatric ocular trauma. This will allow improved clinical care of these injuries.

Role of Scheimpflug Imaging in Traumatic Intralenticular Foreign Body

The role of Pentacam Scheimpflug imaging in evaluation of penetrating eye injury and intralenticular foreign body (ILFB). Interventional case report. A 35-year-old male presented to our clinical practice with penetrating eye injury and endophthalmitis. Scheimpflug imaging helped localize the intralenticular foreign body (ILFB). It confirmed the posterior capsule to be intact. He underwent phacoemulsification, foreign body removal, and intraocular lens (IOL) implant. Postoperatively, IOL was imaged with Pentacam Scheimpflug imaging. Scheimpflug imaging allowed us to confirm the presence and exact location of ILFB and its relation to the intact posterior capsule as well as the postoperative IOL positioning. This helped in better planning of management of traumatic cataract with ILFB. Pentacam is a potential tool for accurate localization of foreign bodies lodged in the lens and provides an objective basis for better patient counseling and surgical planning.

Management of Traumatic Cataracts

Management of Traumatic Cataracts

Management of traumatic cataract in children

Purpose: To evaluate the presentation, mode of management, and clinical outcome of traumatic cataract in children.Setting: L.V. Prasad Eye Institute, Hyderabad, India.Methods: One hundred thirty-seven children (<16 years) who developed traumatic cataract, seen between January 1988 and December 1993, were retrospectively analyzed. Nature of injury, type of cataract, management, and outcome were evaluated.Results: The study group comprised 110 boys and 27 girls. Average follow-up was 11.7 months (range 1 week to 60 months). Most injuries (54.7%) were caused by a stick or a bow and arrow. Most (53.2%) of the cataracts were total. Corneal scarring (60.5%) and iris-related problems (49.6%) were the most common associated findings. Extracapsular cataract extraction with intraocular lens (IOL) implantation was performed in 65.67% of patients. Visual acuity improved from 20/200 or worse in 97.7% of patients preoperatively to 20/60 or better in 74.1 % of patients postoperatively. Seventeen patients had associated posterior segment insult; most failed to recover satisfactory vision. Posterior capsule opacification (PCO) was noted in 42.9% of patients.Conclusions: Extracapsular cataract extraction with IOL implantation provides satisfactory results in children with traumatic cataract. Associated posterior segment complications and development of PCO are the major obstacles to visual rehabilitation.