Visual outcomes with traumatic cataract surgery in mexican children

1
"Visual outcomes with traumatic cataract
surgery in mexican children"

• Asociación para Evitar la Ceguera en México
• Márquez-Alarcón Leticia G, Fuentes-Cataño Martha
  C,
• Fernández-Muñoz Erika, Jiménez-Rosas Diana F
• ASCRS ASOA, April 2009

No financial interest by the authors
2
introduction

• Prevalence of pediatric cataract
• 1 to 4/10 000 in non industrialized countries
• 0.1 to 0.4/10 000 in industrialized countrires ¹
• Traumatic cataracts account for 29 of childhood
  cataracts²
• In indian children 11.6-29²
• It is the most common etiology of acquired
  cataract (90)³
• 80 occur while playing
• Cataracts in children should be treated promptly
  because of the risk of amblyopia

1. Johad K, Vasavada, Gupta. Epidemiology based
   Etiological Study of Pediatric Cataracts in
   Western Ind J Med Sci. 200458115-121
2. Eckstein M et al. Aetiology of childhood
   cataract in South India. Br J Ophthalmol
   1996.80628-32
3. Perucho Martínez. Pediatric cataract
   epidemiology and diagnosis. Retrospective review
   of 79 cases. Arch Soc Esp Oftalmol 20078237-42

3
purpose

• To determine the visual outcome after cataract
  surgery in pediatric mexican patients with
  traumatic cataract secondary to either blunt or
  penetrating trauma
• To determine the most frequent complications
  associated with this pathology
•  

4
methods

• Clinical retrospective, descriptive and
  transversal study done at the Dr. Luis Sánchez
  Bulnes Hospital of the Asociacion para Evitar la
  Ceguera en México
• Inclusion criteria
• Children of 15 years or younger
• Either sex
• With traumatic cataract
• Without lesion in the posterior segment
• At least 3 month follow up period

5
methods

• Exclusion criteria
• Patients with incomplete charts
• Demographic, preoperative , intraoperative and
  postoperative details were transferred from the
  charts to a database
• A total of 54 patients gathered inclusion
  criteria from january 2002 to june 2008 and were
  included in the study

6
results
TABLE 1. Demographic data TABLE 1. Demographic data
Mean age (y) 7.25 3.37
Sex Male Female n 36 (63.1) n 18 (36.8)
Mean time from trauma to hospital (days) 186.12 338.51 Rank 0.5 1642.5
Sclero-corneal injury (penetrating injury) Mean time to corneal repair (days) n 27 (50) 2.18 8.27 Rank 0-60
Mean time to cataract surgery (days) 198.87 326.67 Rank 0-1642.5
Injury on visual axis n 12 (21)
Ocular trauma score 2 - 14 3 38 4 1 5 1
Initial best corrected visual acuity LogMar -2.49 1.02
Follow up (days) 692.12 672.64 Rank 90 - 2920
7
results
Mechanism of injury
TABLE 2. Types of cataract n
Total 26
Nuclear sclerosis 4
Anterior sucapsular opacity 1
Posterior subcapsular opacity 18
Partially reabsorbed 4
8
results
TABLE 3. Primary procedures n
Corneal wound closure 27
Corneal wound closure phacoemulsification IOL 2
Phacoemulsification IOL impantation in the bag in sulcus 47 39 6
Phacoemulsification Aphakia 2
Anterior vitrectomy 17
Posterior circular continous capsulorrhexis 5
Capsular tension ring 4
Other (PKP, valvular implant, ECEC) 3
TABLE 4. Secondary procedures n
Phacoemulsification IOL implantation 5
Anterior vitrectomy 3
Posterior circular continous capsulorrhexis 3
Strabismus surgery 3
Valvular implantation 3
Secondary IOL implantation 2
Others IOL extraction, central vitrectomy, pupilar membrane resection 3
9
results
TABLE 5. INTRAPOERATIVE COMPLICATIONS n
Posterior capsule rupture 2
Iridodyalisis 1
EARLY COMPLICATIONS
Fibrinous anterior uveitis 11
Hiphema 5
Vitreous hemorrhage 3
Angle recession 3
Fibrinoid syndrome 1
Endophthalmitis 1
LATE COMPLICATIONS
Ambliopia 28 (51.8)
Posterior capsular opacity 20 (37)
Leucoma 9
Glaucoma/ocular hipertension 8
Strabismus 3
Others (RD, corneal decompensation, chronic endophtalmitis) 3
12 patiens underwent Yag laser capsulotomy
10
results
Final BCVA
Mean Final LogMar BCVA 30 patients CV 20/60 (52.63) 24 patients CV 20/40 (42.1) 14 patients CV 20/20 (24.5) 18 20/200 -0.78 0.94
Standards Report. International Council of
Ophthalmology 2002. 2. Ophthalmology 1993 100
599-612
11
Other studies eyes (n) IOL() Mean follow up (y) 20/40 () 20/200 ()
Bienfait, 1990 23 - 6.5 70.1 -
Koening, 1993 8 100 0.8 87 0
Anwar,1994 18 83 3.2 80 0
Krishnamachary 1997 137 67.5 0.8 70.8 17.5
Eckstein, 1998 451 100 2.9 67 10
BenEzra,1997 23 - 6.2 65.2 -
Gradin,2001 215 100 5 55.8 12.3
Matiz Moreno, 2005 64 98.7 1 54.7 18.7
Marquez -Alarcon, 2009 54 100 1.89 42.1 33.3
12
conclusion

• Surgical management of traumatic cataracts
  provides a good visual outcome if posterior
  segment is not involved
• Secondary IOL implantation is a good alternative
  in penetrating trauma leading to better visual
  and surgical results¹²
• Posterior capsular opacity is a common
  complication which would require YAG laser
  capsulotomy or posterior capsulorrhexis in a non
  cooperating child expenses and
  amblyopia
• Amblyopia was the most common complication in our
  media
• related to the time patients take to get to
  the hospital???
• Educational programs are needed in order to
  improve visual outcome

1. Curchill AJ. Factors affecting visual outcome in
   children following uniocular traumatic cataract.
   Eye 1995 9 285-291
2. Chuang , Lai Chi-Chun. Secondary intraocular lens
   implantation of traumatic cataract in open-globe
   injury. Can J Ophthalmol 200540454459