ORIGINAL ARTICLE

Visual Outcome of Unilateral Traumatic Cataract

Mariya Nazish Memon, Ashok Kumar Narsani and Noor Bukht Nizamani

ABSTRACT
Objective: To evaluate the visual outcome of a series of patients presenting with unilateral traumatic cataract.
Study Design: Observational study.
Place and Duration of Study: Ophthalmology Department, Liaquat University Hospital, Hyderabad, from July 2007 to
June 2010.
Methodology: Analysis included data of 41 patients (31 males and 10 females) with unilateral traumatic cataract. Data
regarding demographics, causative agent, clinical course and outcome in terms of best corrected visual acuity (BCVA) was
retrieved from the patients files in hospital record. Data was expressed as frequencies, percentages, mean and standard
deviation.
Results: There was a male predilection with a male to female ratio of 3.1:1. The age group more frequently affected was
5 14 years (58.5%). Commonest causative agent was trauma with wooden stick in 13 eyes (31.7%) followed by thorn in
9 eyes (22%) and stone in 7 eyes (17.1%). Pre-existing posterior capsular defects were observed intraoperatively in 6
eyes. Posterior capsular opacification was evident in 10 eyes (24%). Best corrected visual acuity of 6/18 or more at 6
months was achieved in 29 eyes (70.8%). Duration between injury and cataract surgery did not affect the final visual
outcome of traumatic cataract patients.
Conclusion: Patients with traumatic cataract if managed appropriately can have best possible visual outcome. Young
males are commonly affected. Taking protective measures in sports and work as well as patient education can avoid ocular
trauma and traumatic cataract formation.
Key words:

Traumatic cataract. Posterior capsular defects. Posterior capsular opacification. Ocular trauma.

INTRODUCTION
Ocular trauma is the leading cause of unilateral
blindness all over the world.1 Traumatic cataract is a
common sequelae of ocular injuries in adults and
children.2,3 The incidence of ocular injuries varies in
different parts of the world. From India, the reported
incidence is 20.53%,4 and from Pakistan it is 12.9%.5
Management of traumatic cataract that results from
either blunt or penetrating ocular trauma needs special
consideration because of associated injury to ocular and
periorbital structures.
Surgery of traumatic cataract can be primary or
secondary. Primary cataract removal is suggested if the
lens is fragmentized, swollen causing a pupillary block or
to examine the posterior segment otherwise blocked by
lens opacity.6 Secondary cataract removal is more
beneficial because of improved visibility, proper
intraocular lens calculation, and less chances of postoperative inflammation.6
The aim of this study was to evaluate the final visual
outcome of a series of patients with secondary
Department of Ophthalmology, Liaquat University of Medical
and Health Sciences, Jamshoro.
Correspondence: Dr. Mariya Nazish Memon, Department of
Ophthalmology, Liaquat University of Medical and Health
Sciences (LUMHS), Jamshoro.
E-mail: mariyamemon@hotmail.com
Received June 30, 2011; accepted May 30, 2012.

extraction of traumatic cataract along with demographic

features and modes of trauma.

METHODOLOGY
Analysis of medical records of all patients who was
presented with unilateral traumatic cataract, underwent
surgical intervention and completed at least 6 months
follow-up during July 2007 to June 2010 at Department
of Ophthalmology, Liaquat University Hospital,
Hyderabad. Patients of both genders and all age groups
with unilateral traumatic cataract were included in the
study. Patient's data including demographic details,
causative agents, initial visual acuity, intraocular
pressure, slit lamp examination findings, B-scan
findings, treatment / surgery, early and late complications
and final outcome were obtained from patient's chart in
the hospital record. Removal of cataract was performed
as a second and separate procedure in patients of
perforating ocular injury, intraocular lens (IOL)
implantation was performed only in patients with
adequate capsular support. Patients without any
capsular support were kept aphakic. Anterior vitrectomy
was performed in patients with posterior capsular tear
and vitreous prolapse. Patients were subsequently
followed-up on 1 day, 1 week, 6 weeks, 3 months and 6
months postoperatively. At each follow-up visit patient's
visual acuity was recorded. Final best corrected visual
acuity (BCVA) was recorded on the 5th postoperative
visit i.e. at 6 months.

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Mariya Nazish Memon, Ashok Kumar Narsani and Noor Bukht Nizamani

The data processing was carried out on Statistical

Package for Social Science (SPSS) version 10.0
software and expressed as frequencies, percentages,
mean and standard deviation.

RESULTS
Over a period of 3 years i.e. from July 2007 to June
2010, a total of 41 unilateral traumatic cataract patients
were managed at Liaquat University, Eye Hospital,
Hyderabad. Out of a total 41 unilateral traumatic cataract
patients, there were 31 (75.6%) males and 10 (24.4%)
females with a male to female ratio of 3.1: 1. The age
ranged between 5 and 55 years (mean age: 18.5 12
years). The majority of the patients (58.5%) were aged
between 5 and 14 years. Males were affected mostly.
Details are shown in Table I.
Most of the injuries were caused by wooden stick
(31.7%) followed by thorn (22%) and stone (17.1%,
Table II).
The pre-operative visual acuity was perception of light in
31 patients (75.6%), counting finger at 1 meter in 9
patients (22%) and 6/24 in 1 patient (2.4%). Total
cataract was the most prevalent type with a percentage
Table I: Baseline patient demographic characteristics (n = 41).
Age distribution

n (%)

5 - 14 years

24 (58.5)

15 -24 years

7 (17.1)

25 -34 years

4 (9.8)

35 -44 years

3 (7.3)

> 45 years

3 (7.3)

Gender
Male

31 (75.6)

Female

10 (24.4)

Laterality
Right eye

16 (39)

Left eye

25 (61)

Type of Injury
Penetrating

28 (68.3)

Blunt

13 (31.7)

Table II: BCVA versus causative agents.

Causative
agents

Best corrected visual acuity

< 3/60

3/60

6/36

6/18

6/9

Total

6/60

6/24

6/12

6/6

(n)

Punch

2.4

Steel wire

2.4

Goat horn

2.4

Scissor

2.4

Plastic toy

2.4

Stone

17.1

Iron rod

7.3

Wooden stick

13

31.7

Sharp piece
of wood

4.9

Thorn

22.0

Needle

4.9

41

100%

Total

498

Table III: BCVA versus duration between injury and cataract surgery.
Duration

Best Corrected Visual Acuity

between injury < 3/60

and surgery

3/60 -

6/36 -

6/18 -

6/9 -

Total

6/60

6/24

6/12

6/6

(n)

< 1 month

17

41.5

1- 6 months

16

39.0

7-12 months

7.3

> 12 months

12.2

41

100%

Total

of 90%. The other types (rosette, absorbed lens matter,

calcified and posterior sub-capsular) were evenly
distributed comprising 2.4% cases each. Anterior
capsular rupture and corneal scar were the common
associated ophthalmic injuries found in 20 (44%) and 12
(29.3%) patients respectively.
Lens aspiration was done in 36 cases (87.8%), lens
aspiration and anterior vitrectomy in 4 cases (9.7%) and
Phacoemulsification in 1 case (2.4%). Posterior
chamber intraocular lens was implanted in 39 patients
(95%) while 2 (5%) were left aphakic due to inadequate
capsular support. Table III highlights the BCVA in terms
of duration between the injury and cataract surgery.
Majority of the cases had surgery in less than one month
(17 cases) and between 1-6 months (16 cases).
Duration between injury and cataract surgery was not
markedly different among the patients.
The major postoperative complications encountered on
first postoperative day were anterior uveitis in 20
(48.8%) and corneal oedema in 10 (24%) patients which
responded to medical therapy. Posterior capsular
opacity was the only late complication seen in 10
patients (24%) at 6 months postoperatively. In these
patients visual acuity improved to 6/6 6/12 after Nd
YAG laser capsulotomy. The average time between
laser capsulotomy and surgery was 6 months. On first
postoperative day, majority of the patients had visual
acuity ranging between < 3/60 to 6/24, on sixth week
greater part had between 6/36 to 6/6; at sixth month the
best corrected visual acuity of 20 patients (48.8%) was
6/9 to 6/6 and 29 (70.8%) patients had visual acuity of
6/18 or better. The main causes of no improvement in
visual acuity were corneal opacity, high astigmatism,
and macular scar.

DISCUSSION
This study included 41 cases of traumatic cataract
managed at Department of Ophthalmology, Liaquat
University of Medical and Health Sciences, Hyderabad.
Traumatic cataract is one of the most common outcomes
of ocular injuries. There is a 1-15% incidence of
traumatic cataract in ocular injuries.7 Trauma is the
leading cause of 90% of acquired paediatric cataracts.8
In this study, male preponderance was found with a
male to female ratio of 3.1 : 1. It is due to involvement of
males in sports and outdoor activities. Worldwide
Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (8): 497-500

Visual outcome of unilateral traumatic cataract

males are more commonly involved in traumatic cataract

than females.9-11
Zaman et al. stated that majority (50.64%) of the
traumatic cataract patients ranged between 5-15
years,10 which is consistent with the present findings i.e.
58.5% cases ranged between 5-14 years. Sports and
work-related eye injuries most commonly occur in
children and young adults followed by injuries related to
accidents because of involvement of children in high risk
sports without supervision or without employing
protective measures.10 Thompson et al. observed that a
majority of the ocular trauma in children occur at home
due to lack of adult supervision.14
Penetrating injuries are the most common cause of
ocular injuries;12 the same was observed in this study.
Twenty eight patients (68.3%) sustained penetrating
injury whereas 13 patients (31.7%) presented with blunt
injury. The leading cause of injury was wooden stick
(31.7%) followed by thorn (22%) and stone (17.1%).
Krishnamachari13 and Thompson et al.14 also found that
stick and stones were the most frequent cause of injury.
There was no marked difference regarding causative
agents seen on BCVA postoperatively in this series.
In this series, over 90% of cataracts were total, similar
observations were made by Krishnamachari et al.13 and
Panda et al.15 They stated that most of the traumatic
cataracts were total in nature. The ophthalmic injuries
most commonly associated with traumatic cataract were
anterior capsular rupture (48.7%) and corneal scar
(29.2%). Ashvini and colleagues also concluded that
anterior capsule violation (56%) and corneal laceration
(52%) were the most frequent associations with
traumatic cataract.11
Implantation of intra ocular lens (IOL) in traumatized
eyes after removal of traumatic cataract depends on
availability of capsular support. In capsular bag or sulcus
fixation is preferred if there is sufficient capsular and
Zonular support. Patients with insufficient capsular or
Zonular support are the candidate for Artisan lenses,
scleral fixation IOLS and anterior chamber IOLS.16-18
In this study, lens aspiration was done in 36 cases
(87.8%), lens aspiration, posterior capsulotomy and
anterior vitrectomy in 4 cases (9.7%) and
Phacoemulsification in 1 case (2.4%). Posterior
chamber intraocular lens was implanted in 39 patients
while two were left aphakic and planned for scleral
fixated or anterior chamber intraocular lens. Majority of
these patients were operated within 6 months after
trauma. Duration between the injury and cataract
surgery was less than one month in 17 patients (41.5%),
1-6 months in 16 patients (39%), 7-12 months in 3
patients (7.3%) and more than 12 months in 5 patients
(12.2%). Mehul and coworkers19 reported significant
effect of time interval between injury and cataract
surgery on final visual outcome (p=0.02),19 although
these patients did not show that.

The major postoperative complications encountered on

first postoperative day were severe uveitis (48.8%)
which responded to medical therapy. Cheema and
coworker reported that the fibrinous uveitis was the most
common postoperative complication (25%).20 It may
mainly be due to surgical trauma in an already
traumatized eye and not related to type or location of
IOL inside the eye. The commonest late postoperative
complication in these traumatic cataractous eyes was
posterior capsular opacification seen in 10 patients
(24%) at 6 months postoperatively. Eckstein and
colleagues reported that posterior capsular opacity was
seen in almost 92%.21
This study revealed that satisfactory visual outcome in
majority of patients with traumatic cataract could be
safely achieved after cataract removal and IOL
implantation. Best corrected visual acuity was 6/6 to 6/9
in 20 patients (48.8%) and 6/18 or better in 29 patients
(70.8%). Zaman et al.10 and Cheema et al.20 reported
visual acuity of 6/18 or better in 68.7% of patients. Gain
et al. concluded that postoperative visual acuity depends
on complications.22 The main causes of no improvement
in visual acuity in the presently reported patients were
corneal opacity, high astigmatism, and macular scar.
Blindness from ocular trauma can be avoided by
employing protective eye wears especially in high risk
activities. Patient education in schools, baby day care
centres and through media must be carried out to
prevent ocular injuries in children. Once the injury has
occurred, outcome depends on extent of injury to ocular
and peri-orbital structures and immediate and
professional approach must be taken to prevent
blindness.
Limitations of this study were a small sample size and a
fixed follow-up period. This study was conducted at a
tertiary care hospital where large number of complicated
cases were presented for management. It also affected
the surgical success rates and outcome. A majority of
the patients were from rural areas and seen by local
doctors postoperatively for their convenience which
limited the follow-up period.

CONCLUSION
Patients with traumatic cataract can have an optional or
best possible visual outcome depending upon
management and complications. Young males are
commonly affected. Taking protective measures in
sports and work and patient education can avoid ocular
trauma and traumatic cataract formation.

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