Traumatic Cataract Flashcards
what are the different types of injuries resulting in cataracts
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
what structures do trauma affect
trauma is rarely limited to the Lens alone
corneal damage
injury to posterior segment
what are the surgical options for the treatment of traumatic surgery
Surgical options
Depends on extent of injury
Often requires immediate surgery
Lensectomy (aphakic)
IOL implant
what treatment results in a better outcome
Better outcome if IOL implant in children in amblyogenic age group (Rumelt and Rehany, 2010) and Staffieri et al. 2010
what treatment results in better visual prognosis
Generally better visual outcome with IOL implant in both children and adults
Factors affecting post-cataract surgery visual acuity (Qi et al 2016):
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
what have studies shown about visual outcome in paediatric populations with traumatic cataracts
Visual acuity of 6/18 or better (was considered good visual outcome) was achieved by 87.9%,
97.3%, and 97.9% at 1, 6, and 36 months, postoperatively. Eyes which underwent primary posterior capsulotomy and anterior vitrectomy duringcataractsurgery showed statistically better visual outcome than those without it.
how are traumatic cataracts managed In the visually mature
Amblyopia therapy
Traumatic cataract: immediate occlusion post-op (Anwar et al. 1994)
3-4 yrs old: 80% of waking hrs
>4 yrs 90% of waking hrs
No mention <3 yrs old!
Do not delay cataract surgery + immediate and intensive occlusion (Rumelt & Rehany, 2010)
Strabismus
Visually mature
2° strabismus ± c/o diplopia
Binocular diplopia
Decompensated longstanding SO palsy
Masked TED
MG
LR palsy
Surgical trauma
IR restriction
Iatrogenic Brown’s
Traumatic cataract
Monocular form deprivation may disruption of fusion
intractable diplopia
what must be distinguished from diplopia
aniskeikonia must be distinguished from c/o diplopia
what are the bsv outcomes of traumatic cataract
45% have motor fusion & often only gross stereopsis (Garnham and Lee, 1999)
what is the conservative management
exercises
fresnel prisms
inccoorporate prisms
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).
Patients at risk of intractable diplopia are generally more comfortable being aphakic and may abandon aphakic CL.
what are the surgical options for treatment
A forced duction test (FDT) must be performed prior to strabismus surgery to determine tightness of any of the extra-ocular muscle caused by the cataract surgery
