Factors affecting visual outcome in children following uniocular traumatic cataract

Abstract

The correction of paediatric traumatic aphakia remains a controversial topic. This study examines retrospectively the visual outcome in 32 children with uniocular traumatic cataracts. Fifteen received intraocular lens implants following lensectomy, and 17 received aphakic contact lenses. Age range was 2-14 1/2 years at the time of injury. The maximum follow-up time was 13 years. Twenty-four children obtained a good visual result (6/5 to 6/18). These were equally divided between those receiving intraocular lens implants and those with contact lenses. Factors adversely affecting visual outcome are discussed. These include complex trauma, delay in referral for lensectomy, inadequate postoperative correction of aphakia, contact lens difficulties and problems with occlusion therapy. Although aphakic correction with intraocular lens implants may require several subsequent surgical procedures such as capsulotomy, we advise early lensectomy and intraocular lens implantation where possible, particularly in young children with traumatic cataracts. This eliminates contact-lens-associated problems and maximises the chance of good visual outcome and retention of stereoscopic vision.

Rigid gas‐permeable contact lens for visual rehabilitation in aphakia following trauma

“…Previously, CLs were indicated for the treatment of aphakia, [26][27][28] but this caused many difficulties or complications, including technical difficulties in producing high-powered lenses, poor compliance, high replacement costs and keratopathy. 29 The reasons for these problems may be the soft lens materials, design techniques and low DK value of the lenses.…”

The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract

“…The literature addressed traumatic cataract extraction in children. Visual acuity of 20/40 or better was achieved in 45-70% of the children after traumatic cataract extraction [4][5][6]. The cataract may be localized, and when eccentric and small, may not require surgery.…”

“…This study was undertaken to compare primary with secondary cataract extraction and primary versus secondary IOL implantation in a consecutive series of patients with traumatic cataract. The cutting point for best-corrected visual acuity (BCVA) evaluation was 20/40 to allow comparison with pervious studies concerned with traumatic cataract [4][5][6].…”

Catarata pediátrica pós-trauma

“…Em um estudo realizado sobre implante de lentes intra-oculares em crianças portadoras de catarata traumática na África do Sul, os melhores resultados visuais obtidos ocorreram em crianças que tinham mais de cinco anos de idade no momento do trauma, e cujo tempo decorrido entre este e a cirurgia de catarata foi inferior a um ano (8) . Churchill e cols, em um trabalho sobre fatores que afetam o resultado visual em crianças após catarata traumática unilateral, mostraram que o retardo na realização da cirurgia pode afetar adversamente o resultado visual final (9) .…”

“…No entanto, o nível de significância foi maior para os olhos submetidos ao tratamento cirúrgico (p<0,001) quando comparados com os olhos submetidos ao tratamento clínico (p=0,043). Diversos trabalhos na literatura apontam resultados visuais satisfatórios com implante de lente intra-ocular no tratamento da catarata traumática em crianças (2,(5)(6)(8)(9)(10)(11)(12) . O implante de LIO de câmara posterior oferece vantagens por ser um método permanente de correção óptica, fornece uma imagem retiniana estável e provoca aniseiconia mínima.…”