How good are the outcomes of lensectomy to treat traumatic cataract?

For children who have a traumatic cataract, a lensectomy is commonly performed. However, what are the adverse events? Are the visual acuity outcomes good? A new study in JAMA Ophthalmology offers some insight.¹

Investigators looked at children aged 13 and younger who went to pediatric eye care practices within 45 days of undergoing a lensectomy and enrolled them in a multicenter, prospective observational registry. The main outcomes were best corrected visual acuity from 9 to 15 months after the procedure for traumatic cataracts in children aged 3 years and older. The other outcome was the cumulative proportion with glaucoma, strabismus, and other ocular complications by 15 months.

There were 994 children included in the cohort and 84 of them had traumatic cataract. Median age at the time of the procedure for 72 participants was 7.3 (range, 0.1-12.6) years. In 57 of 74 eyes, an intralocular lens was place. In children who were aged 3 years and older at the outcomes, the median best-corrected visual acuity was 20/250 (range, 20/20 to worse than 20/800) in 6 eyes with aphakia and 20/63 (range, 20/20 to 20/200) in 26 eyes with pseudophakia. There was postoperative visual axis opacification found in 18 of 27 eyes with pseudophakia without primary posterior capsulotomy (15-month cumulative proportion, 77%; 95% CI, 58%-92%). Cumulative proportion with glaucoma was 6% (95% CI, 2%-16%) and with strabismus, it was 43% (95% CI, 31%-58%) in 64 participants with ocular alignment data. Extropia occurred in 14 of 23 participants (61%).

The investigators concluded that trauma as the causation of pediatric cataracts needing surgery was uncommon. However, for children with traumatic cataract, there is substantial ocular morbidity, which includes permanent vision loss. Children with traumatic cataract should receive long-term eye and vision monitoring to watch out for glaucoma, strabismus, and capsular opacification.

Reference

1. Freedman S, Enyedi L, Prakalapakorn S, et al. Visual outcomes and complications after lensectomy for traumatic cataract in children. JAMA Ophthalmol. May 6, 2021. Epub ahead of print. doi:10.1001/jamaophthalmol.2021.0980