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Visual outcome in traumatic cataract in Kashmir

Ejaz Akbar Wani, Nowsheen Abdullah Attar, Mohammad Ahsan Dar, Manzoor Qadir Keng, Raashid Maqbool Wani.

Abstract
Background: The most common manifestation of ocular trauma is traumatic cataract, which remains a significant cause of visual impairment and physical disability in spite of diagnostic and therapeutic advances.

Objective: To assess visual outcome in case of traumatic cataract and various factors pre- and postoperatively affecting it.

Material and Methods: The study included 50 patients having traumatic cataract undergoing primary intraocular lens implantation. Personal information and history of the patient were recorded and detailed preoperative assessment was carried out. The surgeries performed were phacoemulsification and conventional extracapsular cataract extraction (ECCE) with lens implantation depending on preoperative status.

Results: A total of 50 patients aged 3–55 years with mean±SD 24.28±14.17 were studied. There were 38 (76%) males and 12 (24%) females; 26 (52%) had closed globe and 24 (48%) open globe injuries. Phacoemulsification was performed in 42 cases (84%) and conventional ECCE in the rest. Posterior chamber intraocular lens (PCIOL) was implanted in 49 cases (41 in bag and 8 in sulcus) and in 1 case anterior chamber intraocular lens was implanted. The most common age group to be affected was between 10 and 30 years (average 22.57 years). Wooden stick was the most common mode of injury (24%) followed by stone chip (20%). Type of cataract was found to be cortical (50%), posterior subcapsular (28%), and total (22%). Paracentral corneal opacity was the most common preoperative complication found in 30 cases (60%). Regarding postoperative visual acuity at 1 week, it was 6/6 in 8 (16%) cases, 6/18 to 6/36 in 24 (48%) cases, and ≤6/60 in 18 (36%) cases. There was absolute improvement in best-corrected visual acuity (BCVA) at 6 months, which was 6/6 to 6/12 in 33 (66%) cases, 6/18 to 6/36 in 16 (32%) cases, and ≤ 6/60 in 1 (2%) case only. On comparison p-value for both was found to be 0.000 (statistically significant). Closed globe injuries had better results than open globe type. Striate keratitis and posterior capsular opacification were the most common postoperative complications found in 20% cases each. Two patients (4%) developed amblyopia.

Conclusion: As youth and children are more prone to injury, adequate adult supervision and educational measures are necessary to reduce prevalence of these accidents. Phacoemulsification is the better surgery because of early refraction stabilization. PCIOL implantation in capsular bag has good results. Children

Key words: Traumatic cataract, posterior chamber intraocular lens (PCIOL), visual acuity (VA), phacoemulsification, best-corrected visual acuity (BCVA)



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