Management of traumatic cataract in adults at a reference center in Mexico City

Abstract

The purpose of the study was to determine the clinical presentation, mode of injury, surgical, and postoperative outcomes in adult patients with traumatic cataract. This is a clinical, observational, and retrospective study with review of records of patients in the period 2010-2012. Eighty patients were included, of whom 67 (83.75 %) were male. The mean age at presentation was 46 years (range 18-82 years). Sixty-four patients (80 %) had a closed-globe blunt ocular trauma and 16 (20 %) had an open-globe penetrating trauma. Seventy-seven (96.25 %) patients underwent phacoemulsification; 13.7 % (n = 11) required placement of capsular tension rings and 22.5 % (n = 18) automated anterior vitrectomy. In 53 % of the cases the intraocular lens (IOL) was placed in the capsular bag. Forty-seven patients (58.75 %) achieved a best-corrected visual acuity of 20/40 or better. In 57 (71.25 %) the final refraction was obtained, with a mean spherical equivalent of -0.56D (range -3.50D to +2.00 D). The improvement in visual acuity was significantly higher when the IOL was placed in the capsular bag compared to when it was placed in the sulcus (average difference of 0.667, p = 0.001). The most common mechanism of trauma is closed globe. Phacoemulsification was the procedure most common performed, with the IOL placed most commonly in the capsular bag. The final best-corrected visual acuity in most patients was 20/40 or better. Placing the IOL in the capsular bag represented an improvement in visual acuity compared to placement in the sulcus.

Prognostic Factors for Visual Outcome in Traumatic Cataract Patients

“…Shah et al reported that the average age was 27 years [6, 11] in India and Serna-Ojeda et al reported that it was 46 years in Mexico [16]. In our study, the ratio of males to females is about 2.1 : 1, different from other reports with ratio 3 : 1 [16, 17]. …”

“…In other researches, these percentages vary from 65.2% to 80% [6, 11, 16, 18, 19]. In our study, only 12.9% underwent phacoemulsification, which is much lower than the 96.3% reported by other researches [16].…”

“…Many other articles have also reported the final VA in traumatic cataract patients. Serna-Ojeda et al reported that 58.7% of cases obtained VA ≥ 20/40 [16]. Rogers et al reported 66.7% of cases obtained VA of >20/60 [20].…”

Traumatic Cataract: A Review

“…Where capsular support is adequate, a three-piece IOL can also be positioned in the ciliary sulcus [43]. It has been shown; however, that improvement in visual acuity is statistically significantly higher when the IOL is placed in the bag compared to in the sulcus [44]. One explanation for this finding is those sulci IOLs incite a greater inflammatory response.…”

Clinical and Socio-Demographical Study of Paediatric Ocular Injuries

“…10 Policy decisions helpful in preventing this kind of trauma and improving the required trauma management services warrant an accurate estimate of the pattern of the ocular trauma in Indian population. 11 Most of our understanding of this issue is based on the studies from developed countries 12,13,14…”