European Journal of Cardiovascular Medicine

Ocular trauma is an important cause of mono-ocular blindness in the world. 40% is related to it. ^[1] Traumatic cataract that may occur after various types of ocular insult is a serious visually challenging sequel of trauma. Domestic injuries are the commonest mode of injury in children. In adults sports and work related eye injuries are common. ^[2]

Traumatic cataract that develops during the early stages of life besides the visual impairment it can also cause amblyopia. Profound visual impairment can result due to stimulus deprivation during the early stage. ^[3] For proper management a detailed history and a pre-operative examination is a must before performing surgery in a case of traumatic cataract. Intraocular foreign bodies and open globe injuries should be ruled out before surgery. ^[4]

The final visual outcomes depend on the type of trauma, extend of lenticular involvement and associated damage to the ocular structures. In adults the time of intervention of cataract surgery should be carried out and completed within a year and within 6 months in children. ^[5]

Surgery for traumatic cataract can be primary or secondary. When the lens is fragmentized, swollen causing a pupillary block or lens opacity blocking the view of posterior segment, primary cataract removal is done. However secondary cataract removal is more beneficial because of improved visibility, proper intraocular lens power calculation, and there is less chances of post operative inflammation. ^[6]

This is a Prospective and Observational study was conducted in the Department of Ophthalmology at Dr. VRK Women's Medical College, Teaching Hospital & Research Center over a period of 1 year.

Inclusion criteria

• Cases willing for participation.
• Cases with penetrating or blunt injury which lead to traumatic cataract formation.

Exclusion criteria

• All others types of cataract like those caused by electric shock, radiation exposure were not included.
• Patients who had history of previous ocular pathology, ocular surgery or congenital malformation.
• Patients not consenting for research.
• Patients with poor compliance to treatment.

Data collection procedure- 60 patients presenting to Eye OPD were enrolled. History was recorded with reference to the following points-

• Demographic profile
• Symptomatology
• Mode of injury
• Activity while injury
• Occupation
• Use of protective measures
• Time interval between injury and presentation to hospital.

The visual acuity was assessed on Snellen’s chart in a semi dark room and converted into log MAR scale for comparison and evaluation. For patients with severe visual loss the visual acuity was recorded in terms of Finger Counting (FC), Hand Movement appreciation (HM) and perception of light (PL).

All the patients enrolled in the study were subjected to detailed meticulous examination of both anterior segment and posterior segment. The anterior segment and adnexa were examined with torch and lamp followed by slit lamp biomicroscopy. Examination of pupillary reaction was done and presence of RAPD or APD or traumatic mydriasis was noted. Fundus examination was done with indirect ophthalmoscope and scleral indentation in patients with blunt injury without hyphema. Periphery was examined for retinal dialysis, retinal tear, commotio retinae. The findings were documented on standard proforma. In presence of opaque media posterior segment was evaluated by B-Scan.

In cases with suspected intraocular/intraorbital foreign body, additional imaging modalities were used such as X-Ray and CT Scan. 

According to BETTS classification patients were categorized as open globe injury and closed globe injury. Tonometry was done by Applanation tonometer in cases of blunt injury. After examination and diagnosis, patients were subjected for routine blood and urine investigations. In cases of polytrauma cardiovascular system, respiratory system, central nervous system and per abdomen were examined. Physician and anaesthetist reference were done for fitness to undergo surgery and surgery was done in presence of anaesthetist.

In the current study majority of the cases were seen in 5-15 years with a male preponderance. 

55% were penetrating trauma and 45% were blunt trauma. Wooden stick was the most common object causing trauma

Associated ocular injuries

Associated ocular injuries go long way in determining the ultimate visual prognosis in cases of traumatic cataract. Corneal and iris injuries were the most common associated injury.

Type of surgery

Depending on the condition of the eye, the type of surgery done were SICS with PCIOL, SICS with PCIOL and lens extraction with anterior vitrectomy

Ocular trauma is a significant cause of vision loss, and as many as 1.6 million people lose sight yearly due to traumatic cataracts. Eye injuries occur in approximately one-fifth of adults, with men and young people being the most commonly affected. ^[7-15] There are an estimated 55 million eye injuries annually, with developed countries experiencing a high incidence of one-sided blindness. Thorough assessment and management of oculofacial trauma are crucial, and guidelines are available to determine the visual prognosis. ^[16] Factors such as initial visual acuity, pupillary reflex response, and the severity of the trauma are essential in this assessment. This activity provides a comprehensive guide to managing lens injuries, particularly traumatic cataracts and surgical indications and timing. Patients can receive the appropriate treatment and care with this approach, leading to better visual outcomes after ocular trauma. ^[17]

Disruption of the lens fibers after blunt or penetrating ocular trauma commonly leads to a traumatic cataract. ^[18] The traumatic mechanism and the integrity of the capsular bag dictate the morphology of the cataract and the clinical course. ^[19] Trauma disrupts and injures the lens fibers, leading to lens swelling. ^[20] Worldwide, traumatic cataract formation is observed in 24% of patients with globe contusions. Concussion cataracts, another type of traumatic cataract, occur due to blunt trauma. Although the lens capsule is not extensively damaged, it becomes progressively opaque over time. The pathophysiology of traumatic cataracts occurs through direct rupture and distortion of the capsule or coup and equatorial expansion due to various forces transferring the traumatic energy to the other side of the eye. ^[21] Traumatic cataracts typically present as rosette or stellate subtypes. ^[22]

The lens comprises the cortex and the nucleus, and the lens capsule is an uninterrupted basement membrane of modified epithelial cells. Denaturation and coagulation of lens proteins can lead to cataract formation through loss of transparency due to degenerative processes. ^[23] Various disturbances can cause these degenerative processes. Disturbances during lens growth and formation lead to congenital cataracts. Fibrous changes in the lens epithelium result in subcapsular cataracts, cortical hydration between lens fibers induces cortical cataracts, and the deposition of pigments such as urochrome leads to nuclear cataracts. ^[24] Trauma can also cause partial (subluxated) or complete (luxated) displacement of the lens, leading to ocular disorders such as phacomorphic glaucoma, in which the lens diameter swells and occludes the iridocorneal angle. (Posttraumatic Crystalline Lens Subluxation) Trauma may also induce lens-particle glaucoma, where lens proteins clog the trabecular meshwork, or an inflammatory response within the anterior chamber leading to the development of phacoantigenic glaucoma. ^[25]

In our study males were predominantly affected by traumatic cataract because of their nature of work and outdoor occupation. The age group of 5-25 years formed the core group of people to get traumatic cataract. Though, in our study most of the patient were fitted with PCIOL and one with ACIOL, newer surgical techniques like PCIOL with capsular tension ring and sclera fixation IOL and other newer technique can be done in complicated cases like zonular dehiscence and/or posterior capsular rupture. The final visual outcome showed good result however the final visual outcome depends upon the extent of associated ocular injuries. Effective Intervention and management are the key points in preventing monocular blindness due to traumatic cataract. 

1. Lin AA, Buckley EG. Update on pediatric cataract surgery and intraocular lens implantation. Curr Opin Ophthalmol. 2010; 21(1): 55-9. DOI: 10.1097/ICU. 0b 013e 32833383cb.
2. Khokhar SK, Pillay G, Agarwal E, Mahabir M. Innovations in pediatric cataract surgery. Indian J Ophthalmol. 2017;65 (3):210-216. DOI: 10.4103/ijo. IJO_860_16.
3. Khokhar S, Gupta S, Yogi R, Gogia V, Agarwal T. Epidemiology and intermediate-term outcomes of open- and closed-globe injuries in traumatic childhood cataract. Eur J Ophthalmol. 2014 Jan-Feb;24(1):124-30.
4. Peleja MB, da Cunha FBS, Peleja MB, Rohr JTD. Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil. BMC Ophthalmol. 2022 Mar 09;22(1):111.