"Visual outcomes with traumatic cataract surgery in mexican children" Asociación para Evitar la Ceguera en México Márquez-Alarcón Leticia G, Fuentes-Cataño Martha C, Fernández-Muñoz Erika, Jiménez-Rosas Diana F ASCRS – ASOA, April 2009 No financial interest by the authors

introduction Prevalence of pediatric cataract : 1 to 4/10 000 in non industrialized countries 0.1 to 0.4/10 000 in industrialized countrires ¹ Traumatic cataracts account for 29% of childhood cataracts² In indian children : 11.6%-29%² It is the most common etiology of acquired cataract (90%)³ 80% occur while playing Cataracts in children should be treated promptly because of the risk of amblyopia Johad K, Vasavada, Gupta. Epidemiology based Etiological Study of Pediatric Cataracts in Western Ind J Med Sci. 2004;58:115-121 Eckstein M et al. Aetiology of childhood cataract in South India. Br J Ophthalmol 1996.;80:628-32 Perucho Martínez. Pediatric cataract: epidemiology and diagnosis. Retrospective review of 79 cases. Arch Soc Esp Oftalmol 2007;82:37-42

purpose To determine the visual outcome after cataract surgery in pediatric mexican patients with traumatic cataract secondary to either blunt or penetrating trauma To determine the most frequent complications associated with this pathology  

methods Inclusion criteria: Clinical retrospective, descriptive and transversal study done at the “Dr. Luis Sánchez Bulnes Hospital” of the Asociacion para Evitar la Ceguera en México Inclusion criteria: Children of 15 years or younger Either sex With traumatic cataract Without lesion in the posterior segment At least 3 month follow up period

…methods Exclusion criteria Patients with incomplete charts Demographic, preoperative , intraoperative and postoperative details were transferred from the charts to a database A total of 54 patients gathered inclusion criteria from january 2002 to june 2008 and were included in the study

results TABLE 1. Demographic data Mean age (y) 7.25 ±3.37 Sex Male Female n = 36 (63.1%) n =18 (36.8%) Mean time from trauma to hospital (days) 186.12 ± 338.51 Rank: 0.5 – 1642.5 Sclero-corneal injury (penetrating injury) Mean time to corneal repair (days) n =27 (50%) 2.18 ± 8.27 Rank: 0-60 Mean time to cataract surgery (days) 198.87 ± 326.67 Rank: 0-1642.5 Injury on visual axis n= 12 (21%) Ocular trauma score 2 - 14 3 – 38 4 – 1 5 – 1 Initial best corrected visual acuity LogMar -2.49 ± 1.02 Follow up (days) 692.12 ± 672.64 Rank: 90 - 2920

…results Mechanism of injury: TABLE 2. Types of cataract n= Total 26 Nuclear sclerosis 4 Anterior sucapsular opacity 1 Posterior subcapsular opacity 18 Partially reabsorbed

…results TABLE 3. Primary procedures n= TABLE 4. Secondary procedures Corneal wound closure 27 Corneal wound closure + phacoemulsification + IOL 2 Phacoemulsification + IOL impantation in the bag in sulcus 47 39 6 Phacoemulsification + Aphakia Anterior vitrectomy 17 Posterior circular continous capsulorrhexis 5 Capsular tension ring 4 Other (PKP, valvular implant, ECEC) 3 TABLE 4. Secondary procedures n= Phacoemulsification + IOL implantation 5 Anterior vitrectomy 3 Posterior circular continous capsulorrhexis Strabismus surgery Valvular implantation Secondary IOL implantation 2 Others: IOL extraction, central vitrectomy, pupilar membrane resection

…results *12 patiens underwent Yag laser capsulotomy TABLE 5. INTRAPOERATIVE COMPLICATIONS n= Posterior capsule rupture 2 Iridodyalisis 1 EARLY COMPLICATIONS Fibrinous anterior uveitis 11 Hiphema 5 Vitreous hemorrhage 3 Angle recession Fibrinoid syndrome Endophthalmitis LATE COMPLICATIONS Ambliopia 28 (51.8%) Posterior capsular opacity 20 (37%)* Leucoma 9 Glaucoma/ocular hipertension 8 Strabismus Others (RD, corneal decompensation, chronic endophtalmitis) *12 patiens underwent Yag laser capsulotomy

…results Final BCVA Mean Final LogMar BCVA 30 patients CV ≥ 20/60 (52.63%) 24 patients CV ≥ 20/40 (42.1%) 14 patients CV ≥ 20/20 (24.5%) 18 ≤20/200 -0.78 ± 0.94 Standards Report. International Council of Ophthalmology 2002. 2. Ophthalmology 1993; 100: 599-612

Other studies eyes (n) IOL(%) Mean follow up (y) ≥20/40 (%) ≤20/200 (%) Bienfait, 1990 23 - 6.5 70.1 Koening, 1993 8 100 0.8 87 Anwar,1994 18 83 3.2 80 Krishnamachary 1997 137 67.5 70.8 17.5 Eckstein, 1998 451 2.9 67 10 BenEzra,1997 6.2 65.2 Gradin,2001 215 5 55.8 12.3 Matiz Moreno, 2005 64 98.7 1 54.7 18.7 Marquez -Alarcon, 2009 54 1.89 42.1 33.3

conclusion Surgical management of traumatic cataracts provides a good visual outcome if posterior segment is not involved Secondary IOL implantation is a good alternative in penetrating trauma leading to better visual and surgical results¹’² Posterior capsular opacity is a common complication which would require YAG laser capsulotomy or posterior capsulorrhexis in a non cooperating child expenses and amblyopia Amblyopia was the most common complication in our media related to the time patients take to get to the hospital??? Educational programs are needed in order to improve visual outcome Curchill AJ. Factors affecting visual outcome in children following uniocular traumatic cataract. Eye 1995; 9: 285-291 Chuang , Lai Chi-Chun. Secondary intraocular lens implantation of traumatic cataract in open-globe injury. Can J Ophthalmol 2005;40:454–459