Refractive and visual outcomes of traumatic cataract surgery: a ten-year perspective
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 3 (2024),
25 January 2025
,
Page 112-118
https://doi.org/10.51329/mehdioptometry205
Abstract
Background: Traumatic cataract is a major consequence of penetrating and blunt ocular injuries, often requiring surgical intervention. We evaluated the visual and refractive outcomes of traumatic cataract surgery and intraocular lens (IOL) implantation in adults who sustained open- or closed-globe injuries.Methods: Patients who underwent cataract surgery and IOL implantation due to closed or open eye injuries were included in this descriptive-analytical, retrospective, case-series study. Eligible patients were scheduled for re-evaluation and a complete ocular re-examination, and individuals who returned and had a follow-up of at least 6 months were ultimately recruited. Because the accuracy of IOL power calculation was a primary outcome, patients who were left aphakic were excluded. Medical records were also reviewed to document baseline data, surgical details, and complications.
Results: We included 72 eyes of 72 patients with a mean (standard deviation [SD]) age of 39.5 (13.6) years and a male-to-female ratio of approximately 6:1. Forty-one (56.9%) eyes sustained open-globe injuries and 31 (43.1%) closed-globe injuries. The mean (SD) initial best-corrected distance visual acuity (BCDVA) was 1.1 (0.6) logarithm of the minimum angle of resolution (logMAR) and improved significantly to 0.3 (0.3) logMAR at the final visit (P < 0.001). A final BCDVA better than 20/40 was detected in 43 (59.7%), 23 (74.2%), and 20 (48.8%) eyes in the entire series, eyes sustaining closed-globe injuries, and those with open-globe injuries, respectively. The absolute prediction error was 1.0 diopter or less in 42 (58.3%) eyes in the entire series. A mean absolute prediction error of 1.0 D or less was more frequent in closed-globe than in open-globe injuries (n = 22 [71.0%] vs. n = 20 [48.8%], respectively). The mean absolute prediction error differed significantly between groups (P < 0.05). Eyes that sustained open-globe injury were less likely to obtain a BCDVA better than 20/40 (odds ratio, 0.33; 95% confidence interval, 0.12 – 0.91; P < 0.05).
Conclusions: Visual acuity significantly improved after traumatic cataract extraction with IOL implantation. Most cases achieved satisfactory visual and refractive outcomes. Eyes with open-globe injuries might have less favorable visual prognosis. These initial findings must be confirmed through large-scale, multi-center longitudinal studies.
Keywords:
- cataracts
- trauma
- open-globe injury
- closed-globe injury
- intraocular lenses
- intraocular lens implantations
- prognoses
- prognostic factors
References
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2. Smith MP, Colyer MH, Weichel ED, Stutzman RD. Traumatic cataracts secondary to combat ocular trauma. J Cataract Refract Surg. 2015 Aug;41(8):1693-8. doi: 10.1016/j.jcrs.2014.12.059. PMID: 26432127.
3. Soleimani M, Cheraqpour K, Salari F, Fadakar K, Habeel S, Baharnoori SM, Banz S, Tabatabaei SA, Woreta FA, Djalilian AR. All about traumatic cataracts: narrative review. J Cataract Refract Surg. 2024 Jul 1;50(7):760-766. doi: 10.1097/j.jcrs.0000000000001424. PMID: 38350230
4. Ram J, Verma N, Gupta N, Chaudhary M. Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India. J Trauma Acute Care Surg. 2012 Sep;73(3):726-30. doi: 10.1097/TA.0b013e31825eeac9. PMID: 22929502.
5. Agarwal A, Kumar DA, Nair V. Cataract surgery in the setting of trauma. Curr Opin Ophthalmol. 2010 Jan;21(1):65-70. doi: 10.1097/ICU.0b013e3283331579. PMID: 19829112.
6. Shah M, Shah S, Upadhyay P, Agrawal R. Controversies in traumatic cataract classification and management: a review. Can J Ophthalmol. 2013 Aug;48(4):251-8. doi: 10.1016/j.jcjo.2013.03.010. PMID: 23931462.
7. Özbilen KT, Alt?nkurt E. Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery. Int Ophthalmol. 2020 Nov;40(11):3163-3173. doi: 10.1007/s10792-020-01502-5. Epub 2020 Jul 10. PMID: 32651906.
8. Chaudhry RK, Rehman AU, Qamar Khan MN, Dad M, Kazi GQ. Visual Outcome Of Paediatric Traumatic Cataract In Paediatric Ophthalmology Department Of A Tertiary Care Hospital. J Ayub Med Coll Abbottabad. 2022 Jan-Mar;34(1):87-90. doi: 10.55519/JAMC-01-8454. PMID: 35466633.
9. Do?an E, Çelik E, Gündo?du KÖ, Alagöz G. Characteristics of pediatric traumatic cataract and factors affecting visual outcomes. Injury. 2023 Jan;54(1):168-172. doi: 10.1016/j.injury.2022.09.034. Epub 2022 Sep 21. PMID: 36167690.
10. Arora K, Arora P, Ganesh S, Gupta S, Das RR. Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma. J Pediatr Ophthalmol Strabismus. 2018 Mar 1;55(2):122-127. doi: 10.3928/01913913-20170703-04. Epub 2017 Nov 14. PMID: 29131915.
11. Rodricks D, Loya A, Mohamed M, Al-Mohtaseb Z. Visual outcomes of open globe injury patients with traumatic cataracts. Int Ophthalmol. 2022 Jul;42(7):2039-2046. doi: 10.1007/s10792-021-02195-0. Epub 2022 Feb 8. PMID: 35133577.
12. Narváez J, Zimmerman G, Stulting RD, Chang DH. Accuracy of intraocular lens power prediction using the Hoffer Q, Holladay 1, Holladay 2, and SRK/T formulas. J Cataract Refract Surg. 2006 Dec;32(12):2050-3. doi: 10.1016/j.jcrs.2006.09.009. PMID: 17137982.
13. Tsiropoulos G, Loukovitis E, Koronis SN, Sidiropoulos G, Tsotridou E, Anogeianakis G. Five generations of intraocular lens power calculation formulas: A review. Medical hypothesis, discovery & innovation in optometry. 2020;1(2):78-99. doi: 10.51329/mehdioptometry111
14. Kinori M, Moisseiev E, Shoshany N, Fabian ID, Skaat A, Barak A, Loewenstein A, Moisseiev J. Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol. 2011 Aug;152(2):291-297.e2. doi: 10.1016/j.ajo.2011.01.049. Epub 2011 Jun 12. PMID: 21664592.
15. Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH; Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology. 2007 Dec;114(12):2142-54. doi: 10.1016/j.ophtha.2007.09.013. PMID: 18054633.
16. Yoo YS, Kang MC, Park J, Kwon HG, Chung ES, Lim DH, Chung TY. Factors affecting prediction error after cataract surgery with implantation of various multifocal IOLs in patients with previous refractive laser surgery. Ann Transl Med. 2021 Dec;9(23):1720. doi: 10.21037/atm-21-3057. PMID: 35071414; PMCID: PMC8743713.
17. Kuhn F, Morris R, Witherspoon CD, Mester V. The Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol. 2004 Feb;27(2):206-10. doi: 10.1016/s0181-5512(04)96122-0. PMID: 15029055.
18. Agrawal R, Shah M, Mireskandari K, Yong GK. Controversies in ocular trauma classification and management: review. Int Ophthalmol. 2013 Aug;33(4):435-45. doi: 10.1007/s10792-012-9698-y. Epub 2013 Jan 22. PMID: 23338232.
19. Perumal D, Dudley RA, Gan S, Boscardin WJ, Gill A, Gelb AW, Lee SJ, Chen CL. Anesthesia Care for Cataract Surgery in Medicare Beneficiaries. JAMA Intern Med. 2022 Oct 3;182(11):1171–80. doi: 10.1001/jamainternmed.2022.4333. Epub ahead of print. PMID: 36190717; PMCID: PMC9531089.
20. Mian SI, Azar DT, Colby K. Management of traumatic cataracts. Int Ophthalmol Clin. 2002 Summer;42(3):23-31. doi: 10.1097/00004397-200207000-00005. PMID: 12131580.
21. Rastogi A, Monga S, Khurana C, Anand K. Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery. Eye (Lond). 2007 Nov;21(11):1367-74. doi: 10.1038/sj.eye.6702451. Epub 2006 Jun 9. PMID: 16763657.
22. Zhong X, Long E, Chen W, Xiang W, Liu Z, Chen H, Chen J, Lin Z, Lin H, Chen W. Comparisons of the in-the-bag stabilities of single-piece and three-piece intraocular lenses for age-related cataract patients: a randomized controlled trial. BMC Ophthalmol. 2016 Jul 8;16:100. doi: 10.1186/s12886-016-0283-4. PMID: 27392024; PMCID: PMC4939005.
23. Chang DF, Masket S, Miller KM, Braga-Mele R, Little BC, Mamalis N, Oetting TA, Packer M; ASCRS Cataract Clinical Committee. Complications of sulcus placement of single-piece acrylic intraocular lenses: recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg. 2009 Aug;35(8):1445-58. doi: 10.1016/j.jcrs.2009.04.027. PMID: 19631134.
24. Zhang H, Zhao J, Zhang LJ, Liu J, Liu Y, Song W, Tian QF, Wang Q, Hamilton DR. Comparison of iris-fixated foldable lens and scleral-fixated foldable lens implantation in eyes with insufficient capsular support. Int J Ophthalmol. 2016 Nov 18;9(11):1608-1613. doi: 10.18240/ijo.2016.11.11. PMID: 27990363; PMCID: PMC5145088.
25. Mian SI, Fahim K, Marcovitch A, Gada H, Musch DC, Sugar A. Nd:YAG capsulotomy rates after use of the AcrySof acrylic three piece and one piece intraocular lenses. Br J Ophthalmol. 2005 Nov;89(11):1453-7. doi: 10.1136/bjo.2005.067405. PMID: 16234452; PMCID: PMC1772911.
26. Shoshany TN, Torjani A, Zhang Q, Syed ZA. Management and Outcomes of Traumatic Cataract During Open Globe Repair. Am J Ophthalmol. 2024 Oct;266:248-254. doi: 10.1016/j.ajo.2024.05.017. Epub 2024 May 25. PMID: 38801873.
27. Okoye GS, Gurnani B. Traumatic Cataract. 2023 Aug 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 37603642.
28. Cohen KL. Inaccuracy of intraocular lens power calculation after traumatic corneal laceration and cataract. J Cataract Refract Surg. 2001 Sep;27(9):1519-22. doi: 10.1016/s0886-3350(01)00872-0. PMID: 11566543.
29. Serna-Ojeda JC, Cordova-Cervantes J, Lopez-Salas M, Abdala-Figuerola AC, Jimenez-Corona A, Matiz-Moreno H, Chavez-Mondragon E. Management of traumatic cataract in adults at a reference center in Mexico City. Int Ophthalmol. 2015 Aug;35(4):451-8. doi: 10.1007/s10792-014-9968-y. Epub 2014 Jul 16. PMID: 25028216.
30. Rumelt S, Rehany U. The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2010 Sep;248(9):1293-7. doi: 10.1007/s00417-010-1378-x. Epub 2010 Jun 29. PMID: 20585800.
31. Hapca MC, Muntean GA, Neme?-Dr?gan IA, Vesa ?C, Nicoar? SD. Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy. J Clin Med. 2023 Nov 8;12(22):6981. doi: 10.3390/jcm12226981. PMID: 38002596; PMCID: PMC10671993.
32. Yalcin Tök O, Tok L, Eraslan E, Ozkaya D, Ornek F, Bardak Y. Prognostic factors influencing final visual acuity in open globe injuries. J Trauma. 2011 Dec;71(6):1794-800. doi: 10.1097/TA.0b013e31822b46af. PMID: 22182891.
33. Yardley AM, Ali A, Najm-Tehrani N, Mireskandari K. Refractive and visual outcomes after surgery for pediatric traumatic cataract. J Cataract Refract Surg. 2018 Jan;44(1):85-90. doi: 10.1016/j.jcrs.2017.09.033. PMID: 29502623.
34. Shah MA, Shah SM, Gosai SR, Gupta SS, Khanna RR, Patel KB, Rathod CD. Comparative study of visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract in children. Eur J Ophthalmol. 2018 Jul;28(4):406-411. doi: 10.1177/1120672117747021. Epub 2018 Feb 26. PMID: 29973068.
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