This article is more than 5 years old. Information may no longer be current.
Penetrating ocular trauma leading cause of pediatric traumatic cataract in India
Retinal involvement was found to be related with the worst visual prognosis, while posterior capsulorrhexis led to better outcomes.
ABU DHABI — Penetrating ocular trauma with wooden sticks and arrows is the leading cause of traumatic cataract in children in central India, both in rural and urban settings, according to a study presented here.
Cataract affects one to 15 per 10,000 children, accounting for 8% to 39% of childhood blindness cases. Eye trauma, which in itself is a leading cause of blindness in children, is one of the most common causes of pediatric cataract.
“In India, 11.6% to 29% of pediatric cataracts are trauma related,” Anupam Sahu, MD, said at the World Ophthalmology Congress.
Study
The study was conducted at the MGM Eye Institute in Raipur, India. The researchers aimed to identify the etiological factors leading to traumatic cataract in children in the city of Raipur and the surrounding rural area, determine the visual outcome following surgery, and analyze the effect of prognostic variables on clinical outcome following surgical management.
The retrospective analysis included 77 eyes of children aged 6 years to 16 years who underwent trauma-related cataract surgery between March 2005 and December 2010. Injuries were classified according to the Ocular Trauma Classification System.
“Twenty children underwent surgical intervention prior to cataract extraction to repair corneal or scleral lacerations. In one case, we performed an intravitreal injection of antibiotics,” Dr. Sahu said.
Cataract extraction was performed with lens aspiration via an anterior approach (62 eyes) or pars plana lensectomy (15 eyes). An IOL was implanted in 61 eyes, mostly via an anterior approach.
“Primary posterior capsulorrhexis with anterior vitrectomy was attempted in all patients but could be done only in 14 eyes. In seven cases we combined lens aspiration with surgical repair of corneal lacerations and/or retinal surgery, mainly for foreign body removal and endophthalmitis,” Dr. Sahu said.
The mean follow-up duration was 11 months (range: 4 weeks to 5 years).
Factors
A higher male prevalence (76%) was found in the study. The mean age at which injuries occurred was 8 years. Injuries more commonly occurred in a rural environment (60%) and were more often open globe injuries (69%). Most (32%) were caused by wooden sticks and arrows in both rural and urban settings, followed by metal, then stone in urban settings and glass in rural areas. The delay between injury and surgery was on average 5.4 months, ranging between 2 days and 6 years.
Visual acuity improved from less than 20/200 in 92% of patients preoperatively to 20/80 or better in 73% postoperatively.
“Retinal involvement was found to be related with the worst visual outcome prognosis,” Dr. Sahu said. “Other prognostic variables, such as type of trauma, delay between injury and surgical time, IOL implantation, and type of IOL implanted were below statistical significance. This lack of correlation indicates a multifactorial involvement.”
Visual axis opacification occurred in 10 eyes (13%), eight of which had secondary interventions, either by YAG capsulotomy (five eyes) or surgical membranectomy (three eyes).
“Having or not having an IOL implanted did not show to be significant, and neither was the type of IOL. In fact, and contrary to expectation, hydrophobic IOLs had a slightly higher rate of opacification (25%) than PMMA (15%),” Dr. Sahu said.
“The one factor that most influenced opacification rate was performing vs. not performing a primary posterior capsulorrhexis with anterior vitrectomy. Primary management of the posterior capsule should be attempted in all cases for better visual outcome,” he said. – by Michela Cimberle
For more information:
Anupam Sahu, MD, can be reached at MGM Eye Institute, 5th mile, Vidhan Sabha Road, Raipur (C.G.), India 493111; +91-771-2284771; fax +91-771-2284774; email: anupam@mgmeye.org.
Disclosure: Dr. Sahu has no relevant financial disclosures.