Traumatic Cataract

Question 1

When do we need to treat traumatic cataract with patching after surgery?

Answer 1

Traumatic cataract cases also need immediate occlusion therapy following surgery. Anwar et al. (1994) recommend occlusion 80% of waking hours in 3-4 years old and 90% of waking hours in children older than 4 years. Occlusion therapy for children younger than 3 years was not mentioned.

Question 2

What are the types of traumatic cataract?

Answer 2

• Open globe injury
  = Full thickness wound of eye wall
  Penetrating injury – typically sharp objects
• Closed globe injury
  =Non-full thickness wound of eye wall
  Blunt injury – e.g. fist, stone, toy
• Other causative agents:
  Electrical injury
  Chemical injury

Question 3

Is trauma usually limited to the lens alone in traumatic cataract?

Answer 3

Trauma is rarely limited to the lens alone
Corneal damage
Injury to posterior segment ~50%

Question 4

What is the most common traumatic injury to cause traumatic cataracts in paeds?

Answer 4

Penetrating eye injury - 88% of paediatric cases (Staffieri et al. 2010)

Question 5

What % of traumatic cataracts are male (adult population), closed globe trauma, penetrating trauma, IOL implant related?

Answer 5

• 85% male
• 80% closed globe trauma
• 20% penetrating trauma
• 96% IOL implant

Question 6

What are the surgical options in traumatic cataract?

Answer 6

Dependent on extent of injury and often requires immediate surgery such as:

IOL implant or Lensectomy (aphakic)

Question 7

How do we get the best visual outcome in traumatic cataracts?

Answer 7

Generally better visual outcome with IOL implant in both children and adults

Question 8

What factors affect post-cataract surgery VA (Qi et al., 2016)?

Answer 8

Initial VA
Better initial VA = better final VA

Type of injury
Open globe injury better than closed injury

Wound location

Type of surgery
IOL implant better than left aphakic

IOL implant method
In the capsule best visual outcome

Question 9

What did Yardley et al (2018) find about paediatric traumatic cataract and VA?

Answer 9

63% of children with closed-globe injuries achieved 20/40 or better

Question 10

What did Jinagal et al. (2018) find about paediatric traumatic cataract and VA?

Answer 10

Good visual outcome 6/18 or better
98% 36 months post-op

Question 11

What did Rumelt & Rehany (2010) find about traumatic cataract and management?

Answer 11

Do not delay cataract surgery + immediate and intensive occlusion (Rumelt & Rehany, 2010)

Question 12

What about traumatic cataract and fusion?

Answer 12

Monocular form deprivation may –> disruption of fusion –>
intractable diplopia

~45% have motor fusion & often only gross stereopsis (Garnham and Lee, 1999)

Question 13

What must we distinguish Aniseikonia from in traumatic cataract?

Answer 13

Must distinguish from c/o diplopia
(Aniseikonia is a binocular vision disorder where the perceived size or shape of images differs between the two eyes, leading to symptoms like double vision, headaches, dizziness, and spatial distortion)

Question 14

What management options are there in secondary strabismus as a result of traumatic cataracts?

Answer 14

Prisms:
Some develop secondary strabismus and may need prisms to retain fusion.

BT:
BT-injection is a valuable tool to assess potential for fusion, assess risk of post-op diplopia and improve cosmesis. This technique has been advocated to evaluate binocular status and improve cosmesis following traumatic cataract before or after cataract surgery (Garnham and Lee, 1999).

Surgery:
FDT (to determine tightness of any EOM caused by the cataract surgery; Hamed, 1991)
Combined cataract and strabismus surgery may be considered in some
May require exercises post-op

Patients at risk of intractable diplopia are generally more comfortable being aphakic and may abandon aphakic CL.