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Traumatic Cataract

Traumatic cataract is an opacification of the eye's normally clear lens due to various kinds of physical and electrical injury, as well as radiation exposure. Trauma is one of the acquired causes of cataracts, but they may also be congenital. The classification of traumatic cataracts usually entails a description of their location and shape.


Presentation

A history of trauma is necessary but may not be recent, as cataracts often develop slowly, and may appear years after the incident. Traumatic cataracts can be unilateral or bilateral. Injury due to blunt trauma is most commonly encountered, although penetrating trauma and other non-mechanical agents can also cause them [1] [2]. Children constitute a sizable proportion of the population affected, and it has been reported that males are significantly more at risk than females [3] [4]. The most frequent patterns of injury seen also vary between different age groups, with children more likely to be injured during play, and young adults during sports. The same applies for residence, as certain types of injuries are more likely to occur in rural rather than urban areas, for instance, accidental injury while collecting wood [1] [5].

Signs of traumatic cataracts are generally the same as those seen in other types of cataracts, with complaints of several visual disturbances such as blurred vision, diplopia, reduced day or night vision, and eventually blindness. The classical shape of trauma related cataracts is rosette or stellate, however traumatic cataracts are not limited to this configuration, given the possible mechanisms of the trauma [6]. On account of the etiology of these cataracts, in addition to the above problems, many patients also have concurrent damage to other ocular, orbital and cranial structures and the severity is often proportional to the force imparted [7].

Asymptomatic
  • Usually almost asymptomatic in young patients, with most complaints concerning blurred vision due to the common corneal astigmatism, it might in time lead to several complications including premature cataract formation and pigmentary glaucoma.[ncbi.nlm.nih.gov]
  • Two eyes (12.5%) had asymptomatic nonprogressive decentration in the early postoperative period; no eye had symptomatic decentration throughout the follow-up.[ncbi.nlm.nih.gov]
Juvenile Cataract
  • cataract H26.09 Other infantile and juvenile cataract H26.1 Traumatic cataract H26.10 Unspecified traumatic cataract H26.11 Localized traumatic opacities Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10[icd10data.com]
  • Malformations and Abnomalities Conjunctiva Cornea Glaucomas, Ocular Hypertension Hypertensive Retinopathy Iris and Ciliary Body Lacrimal System Lens Anatomy and Embryology Cataract and Associated Systemic Diseases (see: Systemic Diseases) Congenital and Juvenile[atlasophthalmology.net]
Juvenile Cataract
  • cataract H26.09 Other infantile and juvenile cataract H26.1 Traumatic cataract H26.10 Unspecified traumatic cataract H26.11 Localized traumatic opacities Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10[icd10data.com]
  • Malformations and Abnomalities Conjunctiva Cornea Glaucomas, Ocular Hypertension Hypertensive Retinopathy Iris and Ciliary Body Lacrimal System Lens Anatomy and Embryology Cataract and Associated Systemic Diseases (see: Systemic Diseases) Congenital and Juvenile[atlasophthalmology.net]
Aniridia
  • We report a case of a 30-year-old woman with aniridia who developed a traumatic cataract related to placement of an Ex-PRESS mini glaucoma shunt. To our knowledge, this potential complication of the device has not been reported.[ncbi.nlm.nih.gov]
  • Pronunciation : Translation Mobile 外伤性内障 traumatica : 创伤性脊椎病... details cataracta : 内障, 白内障... details alopecia traumatica : 损伤性脱发... details aniridia traumatica : 外伤性无虹膜... details cephalhydrocele traumatica : 创伤性头水囊肿... details dermatitis traumatica[eng.ichacha.net]
  • While this lens misplacement occured from trauma, other causes of lens displacement include heriditary conditions (Marfan’s syndrome, homocystinuria, hyperlysinuria sulfite oxidase deficiency, Weill-Marchesani syndrome, aniridia and Ehlers-Danlos syndrome[rootatlas.com]
Corneal Opacity
  • Good visual acuity was achieved in a large proportion of the children despite associated corneal opacities and several intraoperative and postoperative complications.[ncbi.nlm.nih.gov]
  • A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of 6/18.[jcdr.net]
Corneal Opacity
  • Good visual acuity was achieved in a large proportion of the children despite associated corneal opacities and several intraoperative and postoperative complications.[ncbi.nlm.nih.gov]
  • A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of 6/18.[jcdr.net]
Suggestibility
  • Our study suggests that intraocular lens implantation may have a major role in management of monocular cataracts in children.[ncbi.nlm.nih.gov]
  • It is suggested that the posterior chamber IOL can be implanted in traumatic cataract with some injured complications.[ncbi.nlm.nih.gov]
  • Consistent with early reports of the light adjustable IOL, which show positive results in non-LASIK eyes, this case suggests that the light-adjustable IOL may have similar benefits in the post-LASIK eye and other complex situations. Copyright 2012.[ncbi.nlm.nih.gov]
  • The result suggests that the epikeratophakia is one of the best treatment for the pediatric aphakia especially for those who are not optimal for IOL implantation.[ncbi.nlm.nih.gov]
  • We suggest that unilateral cataract or aphakia is associated with excessive eye elongation of affected eyes. Eye elongation seems to be related to amblyopia and poor vision rather than to aphakia.[ncbi.nlm.nih.gov]

Workup

The next step is a thorough ophthalmological exam, ranging from testing visual acuity using the Snellen chart and the range of eye movements to visualizing the eyes' structures through an ophthalmoscope; which may show abnormalities in the red reflex. A slit lamp examination, if available, is best for a more detailed inspection of ocular contents and a clearer view of cataracts. Furthermore, a complete physical examination is important, with emphasis on searching for signs of cranial nerve injury, fractures, intracranial and periorbital hemorrhage.

Imaging studies are necessary, to evaluate the extent of ocular damage and to reveal any foreign bodies that may have been missed. The techniques of ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI) scan are often employed, as they are all useful and have their own advantages [7] [8]. Ultrasound is ideal for assessing intraocular damage as well as detecting foreign bodies, while CT scans show fractures in the orbits and cranium [7]. MRI scans may be used to detect non-magnetic foreign bodies.

Routine blood tests including a full blood count, complete metabolic panel and clotting studies can be done if surgery is anticipated.

Treatment

  • A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction.[ncbi.nlm.nih.gov]
  • We found an isolated posterior capsule rupture on the third day after trauma in a 25-year-old man who was admitted for the treatment of traumatic hyphema and we performed a phacoemusification and anterior vitrectomy with PC-IOL, implantation because of[ncbi.nlm.nih.gov]
  • The result suggests that the epikeratophakia is one of the best treatment for the pediatric aphakia especially for those who are not optimal for IOL implantation.[ncbi.nlm.nih.gov]
  • Treatment of Traumatic Cataract is the same as treatments of other types of cataract but we have to make sure to treat other complications of trauma such as eyelid laceration, corneal wounds, Hyphema and retinal injuries.[webeyeclinic.com]
  • There is no standard classification, investigation, or treatment guidelines for the same. There are controversies regarding predictive models.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSION: Closed-globe injury has more favourable prognosis for the satisfactory ( 20/60) visual recovery after effective management of traumatic cataracts in children.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Open-globe injury has a more favorable prognosis for satisfactory ( 20/60) visual recovery after management of traumatic cataracts.[ncbi.nlm.nih.gov]
  • The management of such cases is an important problem in Ophthalmology and prognosis is variable.[ijo.in]
  • METHODS: Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis.[ijo.cn]
  • Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Indian J Ophthalmol. 2011 May-Jun;59(3):217- 22. doi: 10.4103/0301-4738.81043[medresearch.in]

Etiology

  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • These data suggest that the model of the system's loss of control on the elongation of the eye may provide valuable information and a precise direction for research on etiology and control of myopia.[ncbi.nlm.nih.gov]
  • On account of the etiology of these cataracts, in addition to the above problems, many patients also have concurrent damage to other ocular, orbital and cranial structures and the severity is often proportional to the force imparted.[symptoma.com]
  • Etiology and pathogenesis CATARACT TRAUMATIC (CATARACTA TRAUMATICA) The violation of the integrity of the lens bag with injuries of the eye , usually perforated. Symptoms and course CATARACT TRAUMATIC (CATARACTA TRAUMATICA) Symptoms.[lecheniebolezni.com]
  • Institute, Qingdao , Shandong Province, China Yu-Sen Huang Shandong Eye Institute, Qingdao , Shandong Province, China Li-Xin Xie Shandong Eye Institute, Qingdao , Shandong Province, China Hits : 2328 Download times : 577 Abstract: AIM: To evaluate the etiologies[ijo.cn]

Epidemiology

  • LEVEL OF EVIDENCE: Epidemiologic study, level IV.[ncbi.nlm.nih.gov]
  • The epidemiology and diagnosis of penetrating eye injuries. Acad Emerg Med. 2002 Mar;9(3):209–13. Reddy AK, Ray R, Yen KG. Surgical intervention for traumatic cataracts in children: epidemiology, complications and outcomes.[medresearch.in]
Sex distribution
Age distribution

Prevention

  • The need for adequate health education to prevent ocular injuries and preoperative diagnosis of associated posterior segment complications that may prevent optimal post-operative visual acuity is also noted.[ncbi.nlm.nih.gov]
  • Diagnostic ultrasound examination of eyes with opaque media may be of great value in preventing such cases.[ncbi.nlm.nih.gov]
  • The rehabilitation of the the postoperative vision and the prevention of amblyopia were observed with a mean follow-up period of 20 months. RESULTS: All the lenses remained transparent.[ncbi.nlm.nih.gov]
  • METHODS: The study comprised eyes with traumatic cataract opaque enough to prevent visualization of the posterior lens capsule on slitlamp examination.[ncbi.nlm.nih.gov]
  • In all cases, cataract was dense enough to prevent visualization of the posterior lens capsule. Echography was performed using a 20-MHz probe to detect rupture of the posterior lens capsule.[ncbi.nlm.nih.gov]

References

Article

  1. Khatry SK, Lewis AE, Schein OD, et al. The epidemiology of ocular trauma in rural Nepal. Br J Ophthalmol. 2004;88(4):456–460.
  2. Singh D, Singh K, Singh J, Sood R. The role of intraocular lens in traumatic cataract. Indian J Ophthalmol. 1983;31(3):294–297.
  3. Smith D, Wrenn K, Stack LB. The epidemiology and diagnosis of penetrating eye injuries. Acad Emerg Med. 2002;9(3):209–213.
  4. Cillino S, Cassiccio A, Di Pace F, Pilliteri F, Cillino G. A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area. BMC Ophthalmol. 2008;8:6.
  5. Shah M, Shah S, Shah S, Prasad V, Parikh A. Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Ind J Ophthalmol. 2011;59(3):217–222.
  6. Shah MA, Shah SM, Shah SB, et al. Morphology of traumatic cataract: Does it play a role in final visual outcome? BMJ Open. 2011;1(1):e000060.
  7. Kumar A, Kumar V, Dapling RB. Traumatic cataract and intralenticular foreign body. Clin Exp Ophthalmol. 2005;33(6):660-661.
  8. Yang B, Shan L, Song W, et al. Copolymer-1 immunization reduces damage in retinal ganglion cells under high intraocular pressure through altering the expression of retinal neurotrophins. J Ocul Pharmacol Ther. 2010;26(1):11-19.

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Last updated: 2018-06-22 05:13