Visual outcome of traumatic cataract in pediatric age group

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Name of journal: World Journal of Ophthalmology

ESPS Manuscript NO: 9702

Columns:

Title: Visual Outcome in Traumatic cataract in pediatric age

group

Short running head: Traumatic cataracts in children visual

out come

Authors:

First

Name

Middle

Name

Last

Name

Degre

eDr. Mehul A. Shah MD

Dr.

Shreya

M. Shah MD

Dr. Aarti H. Chaudhry DOMS

Dr.

Lalchand

R. Gupta DOMS

Affiliations all authors:

Drashti Netralaya, Dahod, Gujarat, India

Address of corresponding author:

Drashti Netralaya,

Nr. GIDC, Chakalia Road.

Dahod-389151

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Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232

Email: [email protected]

No financial support received from any company or

institution

This study is not presented at any conference or meeting

Authors do not have any financial interest in any

aspect of this study

Author contributions:

Abstract

Objective: To review results of traumatic cataracts in

children.

Methods:

This is a retrospective cohort study .done at a tertiary eye

care center at the junction of Gujarat, Madhya Pradesh, and

Rajasthan states in central western India.

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We enrolled children with specific inclusion criteria,

examined their eyes to review the co-morbidities due to

trauma, performed surgery for traumatic cataracts, and

implanted a lens, treating amblyopia if applicable. The

patients were re-examined 6 weeks postoperatively. We divided

the traumatic cataract cases into ‘open-globe’ (Group 1) and

‘closed-globe’ (Group 2) groups according to the ocular

trauma based on the Birmingham Eye Trauma Terminology System

(BETTS) and compared the determinants of visual acuity.

Result: Our cohort of 671 eyes with traumatic cataracts in

children included 544 eyes in Group 1 and 127 in Group 2. Six

weeks postoperatively, the visual acuity in the operated eye

was >6/60 in 450(82.7.%) and >/=6/12 215(39.4%) eyes in open

globe group and >20/200 in 127(81.8%) and >/=6/12 36 (28.4%)

eyes in Closed globe group (p = 0.143), and the difference

between the groups was not significant in children. Overall,

402 (39.4%) eyes gained >/=6/60 and >5/12 in 238 (35.4%)

cases. Surgical treatment caused significant difference in

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visual outcome.(p=0.000) When we compared achieved visual out

come compared with ocular trauma score predicted vision.

Conclusions:

Satisfactory visual outcome can be achieved in children with

traumatic cataracts, no significant difference found amongst

open and closed globe injuries in pediatric age group

Ocular trauma score is validated tool to predict visual

outcome.

Key words: Traumatic cataract; pediatric cataract; BETTS;

OTS; Visual outcome;

Core tip: Traumatic cataract in pediatric age group may have

satisfactory visual outcome. Ocular trauma score is a

reliable predictor for visual outcome.

Introduction

Trauma is a cause of monocular blindness in the

developed world, although few studies have addressed the

problem of trauma in rural areas.(1) The etiology of ocular

injury likely differs from that in urban areas and is worthy

of investigation.(2-4) Any prevention strategy requires

knowledge of the cause of injury, which may enable more

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appropriate targeting of resources toward preventing such

injuries. Both eye trauma victims and society bear a large,

potentially preventable burden, (3) as ocular injury in

children has a poor prognosis.

Ocular trauma can `cause cataracts.(1)The methods used

to evaluate the visual outcome in eyes managed for traumatic

and other cataracts are similar,(5) but the damage to other

ocular tissues due to trauma may compromise the visual gain

in eyes operated on for traumatic cataracts. Hence, the

success rates may differ between eyes with these two types of

cataract. Traumatic cataract has a poor visual outcome in

children because of amblyopia and recurrent inflammation.

The introduction of the Birmingham Eye Trauma

Terminology System (BETTS) into clinical practice

standardized the documentation of ocular trauma.(5)

Consequently, it would be interesting to study the visual

outcomes following traumatic cataract surgery and the

determinants predicting the outcome, especially in relation

to the BETTS. Visual outcomes of traumatic cataracts have

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been reported in some cases.(6, 7) However, most reports

involved small samples or were case studies. Gradin et al.(7)

and Morgan et al.(8) reported series focusing on the primary

management of traumatic cataracts and perforating injuries.

In this study, we examined the visual outcomes following

cataract surgery in eyes sustaining injuries in children and

the predictors of satisfactory visual outcomes following the

management of traumatic cataracts in children. Our study was

conducted in a city located at the junction of the Indian

states of Gujarat, Madhya Pradesh, and Rajasthan.(11)

Qualified ophthalmologists at our institute provide low-cost

eye services mainly to poor people belonging to the tribal

population of 4.2 million in this area.

Patients and Methods

We obtained approval from the hospital administrators

and research committee to conduct this study and obtained the

parents’ written consent.

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This was a retrospective study designed in 2002. All

traumatic cataracts in children (≤18 years old) in either eye

diagnosed and managed between January 2003 and December 2009

were enrolled in our study, and those consenting to

participate and not having other serious body injuries were

included. Their data were retrieved from the medical records

and compiled using a pretested online form.

For each patient enrolled in our study, we obtained a

detailed history including the details of the injury and

information on eye treatment and surgery performed to manage

past ocular trauma. Data for both the initial and follow-up

reports were collected using the online BETTS format of the

International Society Ocular Trauma. Details of the surgery

were also collected using a pretested online form. Ocular

trauma score was calculated.(9)

The cases of traumatic cataract were grouped as those

involving open-globe versus those involving closed-globe

injuries. The open-globe injuries were further categorized

into those with lacerations versus rupture. Lacerations of

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the eyeball were subcategorized into eyes with perforating

injuries, penetrating injuries, or injuries involving an

intraocular foreign body. The closed-globe group was

subdivided into lamellar laceration and contusion.

The collected demographic details included patient

entry, residence, and activity at the time of injury, the

object causing the injury, and previous examinations and

treatments. After enrollment, all patients were examined

using a standard method. Visual acuity was checked according

to age using American Academy of Ophthalmology (AAO)

guidelines. The anterior segment was examined using a slit

lamp.

Based on lenticular opacity, the cataracts were

classified as total when an examiner did not observe clear

lens matter between the capsule and nucleus, membranous when

the capsule and organized matter were fused and formed a

membrane of varying density , a white soft cataract with a

ruptured capsule when loose cortical material was found in

the anterior chamber together with a ruptured lens capsule ,

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and a rosette type cataract for a lens with a rosette pattern

of opacity . We could classify all of the cataract cases seen

with this classification. Morphology was influenced mainly by

the type, force, and object of injury and the time interval

between the injury and examination.

For a partially opaque lens, the posterior segment was

examined using indirect ophthalmoscopy and a +20 D lens. When

the optical medium was not clear, a B-scan was performed to

evaluate the posterior segment.

The surgical technique was selected according to

morphology and the condition of tissues other than the lens.

Phacoemulsification was used to operate on cataracts with

hard, large nuclei. With a lens that had either a white soft

or rosette type cataract, unimanual or bimanual aspiration

was used. Membranectomy and anterior vitrectomy, via either

an anterior or a pars plana route, were performed when the

cataract was membranous.

In all patients undergoing corneal wound repair, the

traumatic cataract was managed in a second procedure.

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Recurrent inflammation was more prominent in patients who had

undergone previous surgery for trauma.(9, 10) In such cases,

when the ocular medium was hazy due to inflammation of the

anterior vitreous, we performed a capsulectomy and vitrectomy

via an anterior/pars plana route in adults.

In children younger than 2 years of age, both a

lensectomy and vitrectomy via a pars plana route were

performed, leaving the rim of the anterior capsule available

for secondary lens implantation, and the same surgical

procedures were used to manage the traumatic cataracts. Lens

implantation as part of the primary procedure was avoided in

all children younger than 2 years of age; these children were

rehabilitated with optical correction, and secondary

implantation was done after their second birthday. All

children received supportive amblyopia therapy from a

qualified pediatric orthoptist, and a pediatric

ophthalmologist treated strabismus.

All patients with injuries and without an infection were

treated with topical and systemic corticosteroids and

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cycloplegics. The duration of medical treatment depended on

the degree of inflammation in the anterior and posterior

segments of the operated eye. The operated patients were re-

examined after 24 h, 3 days, and 1, 2, and 6 weeks to enable

refractive correction. Follow-up was scheduled for day 3,

weekly for 6 weeks, monthly for 3 months, and every 3 months

for 1 year.

At every follow-up examination, visual acuity was tested

according to age using the AAO guidelines. The anterior

segment was examined with a slit lamp and the posterior

segment with an indirect ophthalmoscope. Eyes with vision

better than 20/60 at the glasses appointment (6 weeks) were

defined as having a satisfactory grade of vision.

During the examination, data were entered online using a

pretested format designed by the International Society of

Ocular Trauma (initial and follow-up forms), which was

exported to a Microsoft Excel spreadsheet. The data were

audited periodically to ensure completion. We used the

Statistical Package for the Social Studies (SPSS 17) to

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analyze the data. We used descriptive statistics and cross

tabulation to compare the cause and effect of different

variables. The dependent variable was vision >20/60 noted at

the follow-up 6 weeks after cataract surgery. The independent

variables were age, gender, residence, time interval between

the injury and cataract surgery, primary posterior

capsulectomy and vitrectomy procedure, and type of ocular

injury.

We have compared visual out come with predicted visual out

come and analyzed predictive value of predictive model.

Results

Our cohort consisted of 671 patients with traumatic

cataracts, including 544 (81.07%) eyes with open-globe ocular

injuries and 127 (18.9%) eyes with closed-globe injuries. The

patients included 496 (70.9%) males and 196 (29.2%) females.

The mean patient age was 10.53 ± 4.2 years (range 0–17)

(Table 1).

We analyzed several demographic factors, including

patient entry (p = 0.000), cases self-reported as having done

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well (Table 2), socioeconomic status (79% were from lower

socioeconomic classes), and residence (95% were from rural

areas). None was significantly related to the visual acuity

six weeks. according to cross-tabulation and statistical

tests.

The object causing the injury ( Table 3) and the

activity at the time of the injury (p = 0.3; Table 4) were

also not significantly associated with a visual acuity at

six weeks. A stick was the most common agent of injury

(56.1%; Table 3). Better outcome was achieved in 5 years.

(Table-5)

A comparison of the pre- and postoperative visual acuity

showed that treatment significantly improved visual acuity

(Pearson’s χ2 test, p = 0.000; ANOVA, p = 0.001; Table

6)..Morphologically lens ruptured with soft material in

anterior chamber has done significantly better (Table-7)

Aspiration was significantly associated with improved visual

acuity (p = 0.000) and was performed using one or two ports in

48.6% of the patients in the open-globe group .

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Primary posterior capsulotomy and anterior vitrectomy,

commonly performed for eyes with significant inflammation,

caused no significant improvement in the visual acuity

visual acuity at six weeks (p = 0.23).

We also compared these variables in the open-globe and

closed-globe (Tables 8) according to BETTS.

Six weeks postoperatively, the visual acuity in the operated

eye was >6/60 in 450(82.7.%) and >/=6/12 215(39.4%) eyes in

open globe group and >20/200 in 127(81.8%) and >/=6/12 36

(28.4%) eyes in Closed globe group (p = 0.143), and the

difference between the groups was not significant in

children. Overall, 402 (39.4%) eyes gained >/=6/60 and >5/12

in 238 (35.4%) cases. Surgical treatment caused significant

difference in visual outcome.(p=0.000)

We implanted an intraocular lens in 82% of the cases,

90% of which was Poly methyl meth acrylate and 10% acrylic,

5 IOL subluxated or dislocated, Poly methyl meth acrylate

lenses used for secondary implant and 30% of the cases

underwent more than one operative procedure. Of the children,

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30% reported within the first 24 hours of the injury. Time

interval between injury and intervention did not make

significant difference in outcome at six weeks .( p=0.172)

Follow up ranged between 45 days to 1076 days with mean

follow up 71.8 days. Three cases developed secondary

glaucoma.

The final visual outcomes according to the OTS

predictions in children with traumatic cataracts are

presented in Table 9,10 (P = 0.265, 0.22, 0.22, 0.172).

(Figure-1,2,3,4,)

Discussion

Visual gain following surgery for traumatic cataracts is

a complex problem. Electrophysiological (10) and radio-

imaging (11-13) investigations are important tools for

assessing the co-morbidities associated with an opaque lens.

Our study examined patients with open- and closed-globe

injuries who developed traumatic cataracts. A satisfactory

grade of vision following the management of traumatic

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cataracts was significantly more frequent in the eyes with

open-globe injuries (Tables 6 and 7).

Various authors have reported different results in

children with traumatic cataracts: Shah et al.[4] reported

20/60 or better in 56% of their cases; Kumar [13] reported

6/18 or better in 50%; Staffieri, (14) 6/12 or better in 35%;

Bekibele, (15) 6/18 or better in 35.6%; Gradin, (7)20/60 or

better in 64.7% Brar,(17) 0.2 or better in 62%; Cheema, (18)

6/18 in more than 68% of their cases; Karim, (19) 0.2 or

better in 62%; Krishnamachary, (13) 20/60 or better in 74%;

Knight-Nanan, (20) 20/60 or better in 64%; Bienfait, (21) 0.7

in 27%; and Anwar (22) reported 20/40 or better in 73% of

their cases.

Using a polymethyl methacrylate (PMMA) lens, Verma (23)

reported a visual outcome similar to that found in our study.

Eckstein (24) and Zou(25) reported that primary intraocular

lens implantation is important for a better visual outcome,

similar to our results. Also similar to our results, Vajpayee

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(26) and Gupta (27) reported primary insertion of an

intraocular lens with posterior capsule rupture.

Shah (28) reported that a better visual outcome was

achieved when intervention was done between 5 and 30 days in

adults with traumatic cataracts. As in our study, Rumelt (29)

found no significant difference between primary and secondary

implantation.

Staffieri (15) performed primary implantation in 62% of

cases versus 82% in our study. Kumar (14) and Verma (23)

advocated primary posterior capsulotomy and vitrectomy for a

better outcome; our results concurred.

We are not aware of any study that has compared the

visual outcome visual acuity at six weeks in children between

two groups classified using BETTS. Shah et al.(30) reported a

comparison between open- and closed-globe injuries in general

population. We are also not aware of another large series of

successfully treated traumatic cataracts in children.

In our study, final visual outcomes were achieved

according to the OTS 31 prediction in children with traumatic

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cataracts. Although similar findings have been reported by

other 32,33,34, our study presents one of the largest reported

databases following cases of pediatric traumatic cataracts

classified according to BETTS. Despite the long time delay

between injury and treatment in many of the cases in our

study, the OTS was still relevant.

Lesniak and Bauza 32 reported no significant differences

between the final visual acuities and the visual acuities

predicted by OTS in children. Sharma 33 proposed that the OTS

calculated at the initial examination may be of prognostic

value in children with penetrating eye injuries. However,

Unver 34 suggested that OTS calculations may have limited

value as predictors of visual outcome in a pediatric

population. Lima-Gomez Hans and Unver 35 reported estimates

for a 6-month visual prognosis, but some of the variables

required evaluation by an ophthalmologist. Using the OTS,

98.9% of the eyes in the general population could be graded

in a trauma room. Knyazer 36 reported the prognostic value of

the OTS in zone-3 open globe injuries, and Man 37 claimed

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equal prognostic effectiveness of both the OTS and CART in

the general population.

Conclusions:

Satisfactory visual outcome can be achieved in children with

traumatic cataracts, no significant difference found amongst

open and closed globe injuries in pediatric age group.

COMMENTS

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2. Abraham DI, Vitale SI, West SI, Isseme I (1999) Epidemiology of eye injuries in rural Tanzania. Ophthalmic Epidemiol.1999;6:85-94

3. D. Virgil Alfaro, Eric P. Jablon, Monica Rodriguez Fontal, Simon J. Villalba, Robert E.Morris, Michael Grossman, Enrique Roig-Melo Fishing-related ocular trauma. American Journal of Ophthalmology.2005;139: 488-492

4. Shah M, Shah S, Khandekar R.(2008) Ocular injuries and

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visual status before and after Their management in thetribal areas of Western India-A historical cohort studyGrafes Arch Clin Exp Ophthalmol. 2008;246:191–197.

5. Kuhn F, Morris R, Witherspoon CD, Mester V, TheBirmingham Eye Trauma Terminology system (BETT). J FrOphtalmol.2004; 27:206-10.

6. Zhang Y, Zhang J, Shi S. (1998) Determination ofposterior lens capsule status in traumatic cataract withB-Ultrasonography. Zhonghua Yan Ke Za Zhi.1998;34:298-299.

7. Gradin D, Yorston D. Intraocular lens implantation fortraumatic cataract in children in East Africa. JCataract Refract Surg.2001; 27:2017-25.

8. Morgan KS. Cataract surgery and intraocular lensimplantation in children. Curr Opin Ophthalmol.1993;4:54-60.

9. American Society of Ocular Trauma. Ocular trauma Score(OTS) http://www.asotonline.org/ots.html visited on10/12/2008.

10. Behbehani AM, Lotfy N, Ezzdean H, Albader S, Kamel

M, Abul N. open eye injuries in the pediatric population

in Kuwait. Med Princ Pract.2002;11:183

11. Segev Y, Goldstein M, Lazar M, Reider-Groswasser I

CT appearance of a traumatic cataract. AJNR Am J

Neuroradiol.1995;16:1174-1175.

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12. McWhae JA, Crichton AC, Rinke M Ultrasound

Biomicroscopy for the assessment of zonules after ocular

trauma. Ophthalmology. 2003;110:1340-1343.

13. Krishnamachary M, Rathi V, Gupta S Management oftraumatic cataract in children. J Cataract RefractSurg.1997; 23:681-7.

14. Kumar, S., A. Panda, et al. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract. JNMA J Nepal Med Assoc 2008;47: 179-85.

15. Staffieri, S. E., J. B. Ruddle, et al. "Rock, paperand scissors? Traumatic paediatric cataract in Victoria 1992-2006." Clin Experiment Ophthalmol 38: 237-41.

16. Bekibele, C. O. and O. Fasina Visual outcome of traumatic cataract surgery in Ibadan, Nigeria. Niger J Clin Pract 2008; 11: 372-5.

17. Brar, G. S., J. Ram, et al. Postoperative complications and visual results in uniocular pediatric traumatic cataract. Ophthalmic Surg Lasers 2001;32: 233-8

18. Cheema, R. A. and A. D. Lukaris . "Visual recovery in unilateral traumatic pediatric cataracts treated withposterior chamber intraocular lens and anterior vitrectomy in Pakistan." Int Ophthalmol 1999;23: 85-9.

19. Karim, A., A. Laghmari, et al. Therapeutic and prognostic problems of traumatic cataracts. Apropos of 45 cases J Fr Ophtalmol 1998;21: 112-7.

20. Knight-Nanan, D., M. O'Keefe, et al. Outcome and 21

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complications of intraocular lenses in children with cataract. J Cataract Refract Surg1996; 22: 730-6.

21. Bienfait, M. F., J. H. Pameijer, et al. Intraocularlens implantation in children with unilateral traumatic cataract. Int Ophthalmol 1990;14: 271-6.

22. Anwar, M., J. H. Bleik, et al. Posterior chamber lens implantation for primary repair of corneal lacerations and traumatic cataracts in children. J Pediatr Ophthalmol Strabismus 1994;31: 157-61.

23. Verma, N., J. Ram, et al. Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract. Indian J Ophthalmol 59: 347-51.

24. .Eckstein, M., P. Vijayalakshmi, et al. (1998). "Use of intraocular lenses in children with traumatic cataract in south India." Br J Ophthalmol 1998; 82: 911-5.

25. Zou, Y., W. Yang, et al.Primary posterior chamber intraocular lens implantation in traumatic cataract withposterior capsule breaks. Yan Ke Xue Bao 1995;11: 140-2.

26. Vajpayee, R. B., S. K. Angra, et al. Pre-existing posterior capsule breaks from perforating ocular injuries. J Cataract Refract Surg 1994;20: 291-4.

27. Gupta, A. K., A. K. Grover, et al. Traumatic cataract surgery with intraocular lens implantation in children. J Pediatr Ophthalmol Strabismus1992; 29: 73-8.

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28. Shah MA, Shah SM, Shah SB, Patel UA. Effect of interval between time of injury and timing of intervention on final visual outcome in cases of traumatic cataract.Eur J Ophthalmol. 2011 Mar 24. pii:338AC21D-E9FB-42DF-9C28-6FDE61928C9D. doi: 10.5301/EJO.2011.6482. [Epub ahead of print]

29. Rumelt, S. and U. Rehany The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract Graefes Arch Clin Exp Ophthalmol 248(9): 1293-7.

30. Shah MA, Shah SM, Shah SB, Patel CG, Patel UA, Appleware A, Gupta A. Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2011 Jul 7. [Epub ahead of print]

31. Kuhn, F., R. Maisiak, The Ocular Trauma Score (OTS)." Ophthalmol Clin North Am 2001;15(2): 163-5

32. Lesniak, S. P., A. Bauza,Twelve-Year Review of Pediatric Traumatic Open Globe Injuries in an Urban U.S.Population." J Pediatr Ophthalmol Strabismus: 1-7.

33. Sharma, H. E., N. Sharma, Comment on a new ocular trauma score in pediatric penetrating eye injuries." Eye(Lond) 25(9): 1240.

34. Unver, Y. B., N. Acar.Visual predictive value of the ocular trauma score in children." Br J Ophthalmol 2008; 92(8): 1122-4.

35. Lima-Gomez, V., D. M. Blanco-Hernandez, et al. "Ocular trauma score at the initial evaluation of oculartrauma." Cir Cir 78(3): 209-13.

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36. Knyazer, B., J. Levy.Prognostic factors in posterior open globe injuries (zone-III injuries)." ClinExperiment Ophthalmol 2008;36(9): 836-41.

37. Man, C. Y. and D. Steel "Visual outcome after open globe injury: a comparison of two prognostic models--theOcular Trauma Score and the Classification and Regression Tree." Eye (Lond) 24

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Table 1 Age and sex distribution

SEX Tot

alF M0 to 2 6 7 13

3 to 5 27 52 79

6 to 10 74 17

9 253

11 to18 88 23

8 326

Total 195

476 671

Table 2. Patient entry and visual outcome at six weeks

Vision Entry Total Self ORD<1/60 19 0 191/60 to 3/60 68 30 986/60 to 6/36 74 53 1276/24 to 6/18 125 55 180>6/12 to 6/9 178 53 231Un cooperative 11 5 16Total 475 196 671

p = 0.000ORD, [Out reach department]

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Table 3. Object causing the injury

ObjectNumber(n)

Percentage(%)

Ball 9 1.4Cattle horn 11 1.7Cattle tail 2 .3Finger 5 .8Fire 19 2.8Glass 7 1.1Thorn 23 3.4Other 59 8.8Sharp object 59 8.8

Stone 72 10.7Unknown 60 8.8Stick 345 51.4Total 671 100.0

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Table 4. Activity at the time of the injury

ObjectNumber(n)

Percentage(%)

Fall 11 1.7Making a fire

19 2.8

Housework 110 16.4

Employment

38 5.6

Other 85 12.7

Walking 8 1.1

Playing 370 55.1

Travelling

22 3.4

Unknown 8 1.1

Total 671 100.0

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Table 5. Age and visual outcome at six weeks

POST OPERATIVE VISION

Age categoriesTotal

0to2

3to5

6 to10

11 to18

<1/60 2 32 76 83 193 1/60 TO 3/60 1 3 37 35 76 6/60 TO 6/36 7 25 29 19 80 6/24 TO 6/18 1 8 35 40 84 6/12 TO 6/9 1 8 53 89 151 6/6 TO 6/5 1 2 21 60 84 UNCCOPERATIVE 0 1 2 0 3Total 13 79 253 326 671

P=0.000

Table 6. Pre-treat and post-treatment vision comparison


PRE OPERATIVE VISIONTotal

<1/60

1/60 TO3/60

6/60 TO6/36

6/24 TO6/18

6/12TO 6/9 UNCCOPERATIVE

<1/60 182 4 6 0 1 0 1931/60 TO 3/60 70 5 1 0 0 0 766/60 TO 6/36 55 8 15 1 0 1 806/24 TO 6/18 71 10 2 1 0 0 846/12 TO 6/9 125 17 7 1 1 0 1516/6 TO 6/5 64 10 6 4 0 0 84UNCCOPERATIVE 2 0 0 0 0 1 3

Total 569 54 37 7 2 2 671

P=0.000

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Table 7.Comparative study of Morphology of cataract and

visual outcome


MORPHOLOGYTotalMEMBRANOUS ROSETTE

SOFTFLUFFY SUBLUXATED TOTAL

<1/60 45 1 71 2 74 1931/60 TO 3/60 15 2 29 0 30 766/60 TO 6/36 15 4 29 0 32 806/24 TO 6/18 20 2 39 0 23 846/12 TO 6/9 16 6 90 0 39 1516/6 TO 6/5 3 7 53 2 19 84UNCCOPERATIVE 0 0 3 0 0 3

Total 114 22 314 4 217 671

P=0.000

Table 8. Type of injury and visual outcome at six weeks

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p = 0.05

UC, uncorrected vision

Table 9. Comparison of ocular trauma score (OTS)

Final visual outcome

-Ocular Trauma ScoreTotal1 2 3 4 5

Uc 2 2 9 0 2 15Nopl 6 13 0 0 0 19Hmpl 2 27 72 0 0 1011/200 to 19/200 0 15 112 0 0 12720/200 to 20/50 0 40 134 4 0 178≥20/40 0 9 218 4 0 233Total 10 106

545 8 0 671

OTS-Ocular Trauma Score p=0.000

Uc-Uncooperative; Nopl, no light perception

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Vision Category TotalClosed Open1/60 6 12 18

1/60 to 3/60

19 80 99

6/60 to 6/36

29 97 126

6/24 to 6/18

39 138 177

>6/12 30 206 236

UC 6 9 15

Total 127 544 671

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Table 10. Comparison of final visual outcome according to

ocular trauma score (OTS)

Table 10. Comparison of final visual outcome according to ocular trauma score (OTS)

OTS-1 OTS-2 OTS-3 OTS-4VisionCategory

Achieved

FinalVisualAcuity

OTSPredictedFinalVisualAcuity

Achieved

FinalVisualAcuity


Achieved

FinalVisualAcuity


Achieved

FinalVisualAcuity


Nopl

75 73 12 16 0 2 0 1lphm

25 17 25 26 13.5 11 0 21/200to19/200

0 7 14 14 21.3 15 0 220/200to

20/500 2 38 38 24.5 28 50 21

>/=20/40 0 1 00 4 40.5 44 50 74P value P = 0.265 P = 0.220 P = 0.220 P = 0.172

Values are percentage of cases. Nopl, no light perception

Legends:

Figure Legends

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Fig. 1: Comparison between OTS and achieved results in OTS-1

score category.


score category.


score category.


score category.

The English in this document has been checked by at least two

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figure 1

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figure 2

figure 3

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Figure 4

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Visual outcome of traumatic cataract in pediatric age group

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