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Chou BW, Feng S, Ding L, Mudumbai RC. Lens injury in setting of Zone I and II open globe injuries. Indian J Ophthalmol 2025; 73:59-63. [PMID: 39723855 PMCID: PMC11831949 DOI: 10.4103/ijo.ijo_986_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 09/12/2024] [Accepted: 10/07/2024] [Indexed: 12/28/2024] Open
Abstract
PURPOSE To characterize visual outcomes in Zone I and II open globe injuries with lens involvement. SETTING Level 1 Trauma Center Hospital, Seattle WA. DESIGN Retrospective case series. METHODS Zone I and II open globe injuries between May 2009 and May 2018 were reviewed for lens involvement, demographic data, injury characteristics, associated ocular comorbidities, surgical details, and visual outcomes. Eyes with nontraumatic or surgical injuries, prior penetrating keratoplasty, or a history of cataract extraction were excluded. Visual outcomes were compared using the Kruskal-Wallis and Fisher's exact tests. RESULTS A total of 145 Zone I and II globe injuries (63 without lens injury and 82 with lens injury) with at least 6 months of follow-up were included. Endophthalmitis was not identified in any patients without lens involvement, while 9 patients with lens injury (11%) developed endophthalmitis. Patients with lens injury demonstrated a more severe ocular trauma score (P = 0.003). Best-corrected visual acuity (BCVA) was significantly better (P = 0.03) in patients without lens injury compared to those with lens injury. The median (interquartile range) BCVA in the no-lens injury group was 20/40 (20/25 - 20/400), while in the lens injury group it was 20/80 (20/40-20/300). The location of intraocular lens (IOL) placement did not influence final visual acuity outcomes (P = 0.76). However, eyes left aphakic had worse BCVA compared to those that received a secondary IOL (P = 0.005). CONCLUSIONS Open globe injuries with lens involvement are associated with worse visual prognosis. An increased rate of endophthalmitis may contribute to this difference. In eyes requiring secondary IOL placement, the location of the IOL did not affect final BCVA.
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Affiliation(s)
- Brian W Chou
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Shu Feng
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Raghu C Mudumbai
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
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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; 50:760-766. [PMID: 38350230 PMCID: PMC11196203 DOI: 10.1097/j.jcrs.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Abstract
Ocular trauma is an important cause of monocular blindness worldwide. Injury to the lens after blunt or penetrating trauma is common and can result in vision impairment. Selecting the most appropriate therapeutic approaches depends on factors such as patients' age, mechanism of trauma, and underlying clinical conditions. Early management, especially within childhood, is essential because of the difficulties involved in examination; anatomical variations; as well as accompanying intraocular inflammation, amblyopia, or vitreoretinal adhesions. The objective of this study was to provide a comprehensive review of the epidemiology and clinical management of traumatic cataract, highlighting the significance of accurate diagnosis and selection of the optimal therapeutic approach.
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Affiliation(s)
- Mohammad Soleimani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Salari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Fadakar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samer Habeel
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Seyed Mahbod Baharnoori
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Soraya Banz
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- University of Edinburgh, UK
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fasika A. Woreta
- Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Ali R. Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Open Globe Injury (OGI) with a Presence of an Intraocular Foreign Body (IOFB)-Epidemiology, Management, and Risk Factors in Long Term Follow-Up. J Clin Med 2022; 12:jcm12010190. [PMID: 36614991 PMCID: PMC9821012 DOI: 10.3390/jcm12010190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.
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Henry RK, Bargoud A, Syal S, Tadrosse A, Shaikh IS, Kost RL, Khouri AS. The impact of primary repair timing on longitudinal visual outcomes after open globe injury. Graefes Arch Clin Exp Ophthalmol 2022; 261:1195-1203. [PMID: 36383277 DOI: 10.1007/s00417-022-05904-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/05/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The urgency with which to repair open globe injuries is a debated topic that lacks grounding in longitudinal visual outcomes data. We aim to test the association between primary repair timing and visual recovery potential following OGI. SUBJECTS/METHODS We performed a retrospective cohort study of medical records from a US academic medical center (7/2017 to 11/2021). We included all patients with a principal diagnosis of OGI, a documented date and time of injury, presentation, repair, and ≥ 3 months of complete follow-up data on visual outcomes. We excluded those with prior OGI in the same eye. We also tested the correlation of injury to repair time (ITR) in hours with best corrected visual acuity (BCVA, in logMAR units) at last follow-up in the general cohort and select subpopulations and the impact of repair delay on visual improvement over the follow-up period. RESULTS One hundred twenty-nine patients with OGI were analyzed (91 patients with ≥ 3 months of follow-up). The majority were male (105/129, 81%) with a median age of 45 years. Most OGI involved zone 1 (57%), followed by zone 3 (24%), and zone 2 injuries (19%). Median ocular trauma score (OTS) was 60 (IQR 37-70); mean presenting BCVA was logMAR 1.9 (median 2.3, IQR 1.0-2.7). Median ITR was 22 h (IQR 15-30 h, range 5-199 h). ITR time did not significantly correlate with final BCVA (n = 91, β = - 0.003, 95% CI - 0.009-0.002, P = 0.233), nor did it significantly increase the odds of developing ocular complications or requiring secondary ocular surgeries (OR 0.985, 95% CI 0.967-1.002, P = 0.085). Additionally, the rate of BCVA improvement over subsequent months of follow-up did not significantly differ based on ITR time. Presenting BCVA (R2 = 0.701, P < 0.001) and OTS (R2 = 0.477, P < 0.001) significantly correlated with final BCVA, independent of repair delays. CONCLUSIONS In this cohort of OGI patients, repair timing does not significantly correlate with final BCVA, and delays beyond 24 h do not significantly correlate with worse visual recovery potential. Repair time alone should be emphasized to a lesser extent as a prognosticator of visual potential, in favor of significant predictors such as the ocular trauma score and presenting visual acuity.
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Günaydın NT, Oral AYA. Pediatric traumatic cataracts: 10-year experience of a tertiary referral center. BMC Ophthalmol 2022; 22:199. [PMID: 35501774 PMCID: PMC9063203 DOI: 10.1186/s12886-022-02427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Nesrin Tutaş Günaydın
- Department of Ophthalmology, University of Health Sciences, Dr. Lütfi Kırdar Kartal City Hospital, Denizer Cad. No:1, 34865, Cevizli, 34100, İstanbul, Turkey.
| | - Ayşe Yeşim Aydın Oral
- Department of Ophthalmology, Afyonkarahisar University of Health Sciences, 03200, Afyonkarahisar, Turkey
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Visual outcomes of open globe injury patients with traumatic cataracts. Int Ophthalmol 2022; 42:2039-2046. [PMID: 35133577 DOI: 10.1007/s10792-021-02195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Open globe injury (OGI) is a serious form of ocular trauma that can significantly lower quality of life post-injury due to comorbidities. This study was designed to investigate how traumatic cataracts and other pre-operative variables affect visual outcomes of OGIs. METHODS A retrospective review was conducted for OGI patient records with presence of traumatic cataracts, visual outcomes, comorbidity data and provider training. Multivariable logistic regression analysis determined if several pre-operative variables including traumatic cataracts, retinal detachment and hyphema were predictive of final visual acuity and need for retinal surgery. Ancillary multivariable analysis was conducted to evaluate if timing of traumatic cataract extraction predicted poor final visual acuity. RESULTS Multivariable logistic regression analysis did not find traumatic cataract to be an independent predictor of final visual outcome in the open globe injury sample population (n = 102, p = 0.386), but did find retinal detachment (p = 0.008), hyphema (p = 0.035) and scleral laceration (p = 0.009) to be independent predictors of poor final visual acuity. In the subgroup of eyes with traumatic cataract (n = 64), delayed cataract extraction was not found to be an independent predictor of poor final visual acuity (p = 0.156). CONCLUSION Our results suggest that retinal detachment, hyphema, and scleral laceration influence final visual outcome while traumatic cataract does not. Within the subpopulation of patients that received lens extraction, timing of extraction was not found to independently influence final visual acuity.
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Besek NK, Nacaroglu SA, Er MO, Kirgiz A, Yilmaz FO, Yildiz BK, Ocal MC. The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases After Open Globe Injury. ACTA ACUST UNITED AC 2021; 35:368-375. [PMID: 34344135 PMCID: PMC8521333 DOI: 10.3341/kjo.2020.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury. Methods The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012-2019. Demographic characteristics, trauma zone, ocular trauma score (OTS), type of injury, time of secondary IOL implantation, final best corrected visual acuity (BCVA), and complications were recorded for each patient. Results The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40±0.86 LogMAR, while the postoperative final BCVA was found to be 0.53±0.70 LogMAR (p<0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r= 0.140, p=0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA LogMAR (r=0.895, p<0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p= 0.007). Conclusion Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.
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Affiliation(s)
- Nilay Kandemir Besek
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Senay Asik Nacaroglu
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Onur Er
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kirgiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Fevziye Ondes Yilmaz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burçin Kepez Yildiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery. Int Ophthalmol 2020; 40:3163-3173. [PMID: 32651906 DOI: 10.1007/s10792-020-01502-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
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.
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Wong JX, Assia EI. Intraocular foreign body and traumatic cataract removal 65 years after penetrating trauma. Eur J Ophthalmol 2020; 31:NP15-NP18. [PMID: 31973552 DOI: 10.1177/1120672120902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of successful intraocular foreign body/traumatic cataract removal and anterior segment reconstruction surgery of a patient's eye that suffered penetrating injury 65 years earlier. Surgery was not recommended by ophthalmologists that she had earlier consulted. The patient opted for surgery to improve cosmesis due to leukocoria, but the level of regained vision exceeded expectations of both the patient and the surgeon. This case adds further evidence that the duration of occlusion time has no effect on visual potential in patients out of amblyogenic age. The ethical considerations of operating on such an eye with poor prognosis after traumatic injury are also discussed. To our knowledge, our patient has the longest reported duration (65 years) between the time of injury and successful surgery with good outcome.
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Affiliation(s)
- John Xh Wong
- Center for Applied Eye Research, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ehud I Assia
- Center for Applied Eye Research, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ein Tal Eye Center, Tel Aviv, Israel
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Early versus late traumatic cataract surgery and intraocular lens implantation. Eye (Lond) 2017; 31:1199-1204. [PMID: 28409771 DOI: 10.1038/eye.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/24/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.
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Prognostic Factors for Visual Outcome in Traumatic Cataract Patients. J Ophthalmol 2016; 2016:1748583. [PMID: 27595014 PMCID: PMC4993940 DOI: 10.1155/2016/1748583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/12/2016] [Indexed: 01/31/2023] Open
Abstract
Purpose. To investigate the prognostic factors for visual outcome in traumatic cataract patients. Methods. The demographic features of traumatic cataract patients in Central China were studied. The factors that might influence the visual outcome were analyzed. The sensitivity and specificity of OTS (ocular trauma score) in predicting VA were calculated. Results. The study enrolled 480 cases. 65.5% of patients achieved VA at >20/60. The factors associated with the final VA were initial VA, injury type, wound location, the way of cataract removal, and IOL implantation. The sensitivities of OTS in predicting the VA at NLP (nonlight perception), LP/HM (light perception/hand motion), and ≥20/40 were 100%. The specificity of OTS to predict the final VA at 1/200-19/200 and 20/200-20/50 was 100%. Conclusion. The prognostic factors were initial VA, injury type, wound location, cataract removal procedure, and the way of IOL implantation. The OTS has good sensitivity and specificity in predicting visual outcome in traumatic cataract patients in long follow-up.
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Smith MP, Colyer MH, Weichel ED, Stutzman RD. Traumatic cataracts secondary to combat ocular trauma. J Cataract Refract Surg 2015; 41:1693-8. [DOI: 10.1016/j.jcrs.2014.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 12/01/2022]
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Shah MA, Shah SM, Chaudhry AH, Pannu S. Traumatic cataracts in children: Visual outcome. World J Ophthalmol 2015; 5:80-85. [DOI: 10.5318/wjo.v5.i2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 01/24/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review results of traumatic cataracts in children.
METHODS: Only those pediatric patients who fitted in the definite inclusion criteria were considered for study enrollment. They were further examined for any kind of co-morbidities because of trauma, operated upon for traumatic cataracts with intraocular lens implantation. Amblyopia if present was treated. All were re-examined at the culmination of six-week postoperative period. According to the Birmingham Eye Trauma Terminology System the traumatic cataract cases were divided into group 1 (open globe) and group 2 (closed globe), and then determinants of visual acuity were compared.
RESULTS: There were 544 eyes in group 1 and 127 eyes in group 2 in our study of 671 eyes with pediatric traumatic cataracts. Visual acuity at the end of 6 wk after surgery in the operated eye was > 6/60 in 450 (82.7%) and ≥ 6/12 in 215 (39.4%) eyes in the open globe group and > 20/200 in 127 (81.8%) and ≥ 6/12 in 36 (28.4%) eyes in the closed globe group (P = 0.143), and the difference between the groups was not significant in children. Overall, 402 (39.4%) eyes gained ≥ 6/60 and > 5/12 in 238 (35.4%) cases. Surgical treatment caused a significant difference in visual outcome (P = 0.000). When we compared achieved visual outcome with ocular trauma score predicted vision, no significant difference was found.
CONCLUSION: Traumatic cataracts in children may have better outcome and ocular trauma score is a useful predictive method for the ocular trauma in children.
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Shah M, Shah S, Gupta L, Jain A, Mehta R. Predictors of visual outcome in traumatic cataract. World J Ophthalmol 2014; 4:152-159. [DOI: 10.5318/wjo.v4.i4.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/21/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.
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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 2014; 35:451-8. [PMID: 25028216 DOI: 10.1007/s10792-014-9968-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Juan Carlos Serna-Ojeda
- Anterior Segment Department, Instituto de Oftalmologia "Conde de Valenciana", Chimalpopoca 14, 06800, Mexico, DF, Mexico,
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Shah M, Shah S, Upadhyay P, Agrawal R. Controversies in traumatic cataract classification and management: a review. Can J Ophthalmol 2014; 48:251-8. [PMID: 23931462 DOI: 10.1016/j.jcjo.2013.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/21/2013] [Accepted: 03/15/2013] [Indexed: 12/25/2022]
Abstract
Traumatic cataract is one of the important causes of blindness after ocular trauma, either open or close globe. Visual outcome is unpredictable because it is not only lens that decides visual outcome. There is no standard classification, investigation, or treatment guidelines for the same. There are controversies regarding predictive models. We would like to highlight these controversies and try to reach certain guidelines that may help clinicians to manage traumatic cataracts.
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Affiliation(s)
- Mehul Shah
- Drashti Netralaya, Dahod, Gujarat, India.
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Rao R, Sasidharan A. Iris claw intraocular lens: a viable option in monocular surgical aphakia. Indian J Ophthalmol 2013; 61:74-5. [PMID: 23412525 PMCID: PMC3638330 DOI: 10.4103/0301-4738.107198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To evaluate the safety and efficacy of iris claw intraocular lens (IOL) implantation for correction of monocular surgical aphakia in eyes with no capsular support. This is a prospective interventional case series of 30 eyes of monocular surgical aphakia. Patients underwent posterior iris claw implantation 4 weeks after the primary surgery. Aphakia which resulted due to posterior capsular rupture, large zonulo-dialysis (>180°) and cases of intracapsular cataract extraction in subluxated cataractous lens (>180°) where a posterior chamber IOL could not be placed were included in this study. Postoperatively, best-corrected visual acuity (BCVA) improved significantly (P < 0.02), 80% of patients had good vision of (20/20 to 20/40) and endothelial cell loss was 8.96% at 6 months. Secondary iris claw intraocular lens implantation is a viable option to correct monocular aphakia in eyes without capsular support.
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Kinori M, Tomkins-Netzer O, Wygnanski-Jaffe T, Ben-Zion I. Traumatic pediatric cataract in southern Ethiopia--results of 49 cases. J AAPOS 2013; 17:512-5. [PMID: 24160973 DOI: 10.1016/j.jaapos.2013.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/20/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the experience of two tertiary care facilities in southern Ethiopia in the treatment of traumatic pediatric cataract for a period of more than 1 year. METHODS The medical records of consecutive traumatic pediatric cataract patients who underwent surgery at the Hawassa University and the Yirgalem University schools of medicine from July 2007 to August 2008 were retrospectively reviewed. All patients with a follow-up of at least 12 months were included. RESULTS A total of 49 children were included. Mean patient age was 8.6 ± 0.3 years (range, 5-15 years). Of the 49 cases, 32 (65%) were caused by blunt trauma. Average follow-up period was 15 months. Postoperative visual acuity of counting fingers or better was achieved in 43 (88%) eyes compared with 5 (10%) at presentation (P < 0.0001). Better visual acuity at presentation and blunt trauma were associated with better final visual acuity. Only blunt trauma was found by multivariate analysis to influence final visual acuity (P = 0.0001). CONCLUSIONS Visual acuity of counting fingers or better visual can be achieved in most cases. Blunt trauma is a good independent prognostic factor for visual acuity.
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Affiliation(s)
- Michael Kinori
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Dr Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
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Xu YN, Huang YS, Xie LX. Pediatric traumatic cataract and surgery outcomes in eastern China: a hospital-based study. Int J Ophthalmol 2013; 6:160-4. [PMID: 23638416 DOI: 10.3980/j.issn.2222-3959.2013.02.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 03/05/2013] [Indexed: 11/02/2022] Open
Abstract
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.
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Affiliation(s)
- Ying-Nan Xu
- Weifang Medical University, Weifang 261053, Shandong Province, China ; Shandong Eye Institute, Qingdao 266071, Shandong Province, China
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Moreschi C, Da Broi U, Lanzetta P. Medico-legal implications of traumatic cataract. J Forensic Leg Med 2013; 20:69-73. [DOI: 10.1016/j.jflm.2012.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
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Controversies in ocular trauma classification and management: review. Int Ophthalmol 2013; 33:435-45. [PMID: 23338232 DOI: 10.1007/s10792-012-9698-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.
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Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India. J Trauma Acute Care Surg 2012; 73:726-30. [PMID: 22929502 DOI: 10.1097/ta.0b013e31825eeac9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Ocular Trauma Score as a predictor of final visual outcomes in traumatic cataract cases in pediatric patients. J Cataract Refract Surg 2012; 38:959-65. [PMID: 22624894 DOI: 10.1016/j.jcrs.2011.12.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/01/2011] [Accepted: 12/02/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE To validate the predictive value of the Ocular Trauma Score (OTS) in children with traumatic cataract. DESIGN Retrospective cohort study. SETTING Tertiary eye care center at nexus of Gujarat, Madhya Pradesh, and Rajasthan states, central Western India. METHODS After meeting inclusion criteria, eyes with traumatic cataract were enrolled and examined to review comorbidities caused by trauma. Surgery was performed for traumatic cataract, intraocular lenses were implanted, and patients were treated for amblyopia, as applicable. Patients were reexamined 6 weeks postoperatively. Based on ocular trauma described according to the Birmingham Eye Trauma Terminology System, the patients were divided into 2 traumatic cataract groups: open-globe injury and closed-globe injury. The relationship between final corrected distance visual acuity (CDVA) and demographic and clinical variables was analyzed. Visual outcomes were predicted using the OTS, and the predictions were compared with actual outcomes using statistical tests. RESULTS The study enrolled 354 children. Six weeks postoperatively, the CDVA was better than 20/200 in 181 eyes (63.0%) and 20/40 or better in 110 eyes (38.4%) in the open-globe group and better than 20/200 in 36 eyes (53%) and 20/40 or better in 15 eyes (22.4%) in the closed-globe group. The differences between the groups were not significant (P=.143). Of all eyes, 214 (61.3%) achieved a final CDVA of better than 20/200 and 123 eyes (35.3%), of 20/40 or better. CONCLUSION The OTS was a reliable predictor of the final visual outcome in cases of pediatric traumatic cataract.
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Duma SM, Bisplinghoff JA, Senge DM, McNally C, Alphonse VD. Eye injury risk from water stream impact: biomechanically based design parameters for water toy and park design. Curr Eye Res 2012; 37:279-85. [PMID: 22440159 DOI: 10.3109/02713683.2011.626911] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Interactive water displays are becoming increasingly popular and can result in direct eye contact. Therefore, the purpose of this study is to investigate eye injury risk from high speed water stream impacts and to provide biomechanically based design parameters for water toys and water park fountains. METHODS An experimental matrix of 38 tests was developed to impact eight porcine eyes with water streams using a customized pressure system. Two stream diameters (3.2 mm and 6.4 mm) were tested at water velocities between 3.0 m/s and 8.5 m/s. Intraocular pressure was measured with a small pressure sensor inserted through the optic nerve and used to determine the injury risk for hyphema, lens dislocation, retinal damage, and globe rupture for each impact. RESULTS Experimental water stream impacts created a range of intraocular pressures between 3156 mmHg and 7006 mmHg (61 psi to 135 psi). Injury risk varied between 4.4%-27.8% for hyphema, 0.0%-3.0% for lens dislocation, and 0.1%-3.3% for retinal damage. All tests resulted in 0.0% injury risk for globe rupture. The two water stream diameters did not result in significantly different water stream velocities (P = 0.32); however, the variation in water stream diameter did result in significantly different intraocular pressures (P = 0.03) with higher pressures for the 6.4 mm stream. CONCLUSIONS This is the first study to experimentally measure intraocular pressure from high speed water stream impacts and quantify the corresponding eye injury risk. It is recommended that toy water guns and water park fountains use an upper threshold of 8.5 m/s for water stream velocities to minimize the risk of serious acute eye damage from impacts.
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Affiliation(s)
- Stefan M Duma
- Center for Injury Biomechanics, Virginia Tech-Wake Forest University, Blacksburg, VA 24061, USA.
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Visual Outcome of Traumatic Cataract in Pediatric Age Group. Eur J Ophthalmol 2012; 22:956-63. [DOI: 10.5301/ejo.5000111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2011] [Indexed: 11/20/2022]
Abstract
Purpose. To review results of traumatic cataracts in children. Methods. This is a retrospective cohort study done at a tertiary eye care center at the junction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. We enrolled children with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted a lens, treating amblyopia if applicable. The patients were re-examined 6 weeks postoperatively. We divided the traumatic cataract cases into open-globe (group 1) and closed-globe (group 2) groups according to the ocular trauma based on the Birmingham Eye Trauma Terminology System and compared the determinants of visual acuity. Results. Our cohort of 354 eyes with traumatic cataracts in children included 287 eyes in group 1 and 67 in group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/200 in 181 (63%) and ≥20/40 in 109 (38%) eyes in the open-globe group and >20/200 in 36 (53%) and ≥20/40 in 16 (22.4%) eyes in the closed-globe group (p = 0.143), and the difference between the groups was not significant in children. Overall, 125 (35.3%) eyes gained a visual acuity at 6 weeks of ≥20/40 and >20/200 in 214 (61.3%) cases. Conclusions. Satisfactory visual outcome can be achieved in children with traumatic cataracts, with no significant difference found among open- and closed-globe injuries in the pediatric age group.
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Duma SM, Bisplinghoff JA, Senge DM, McNally C, Alphonse VD. Evaluating the Risk of Eye Injuries: Intraocular Pressure During High Speed Projectile Impacts. Curr Eye Res 2011; 37:43-9. [DOI: 10.3109/02713683.2011.601841] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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