1. "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

2. introduction Prevalence of pediatric cataract :
1 to 4/ in non industrialized countries
0.1 to 0.4/ 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 ;58:
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

3. 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

4. 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

5. …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

6. 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) ±
Rank: 0.5 –
Sclero-corneal injury (penetrating injury)
Mean time to corneal repair (days)
n =27 (50%)
2.18 ± Rank: 0-60
Mean time to cataract surgery (days) ±
Rank:
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) ±
Rank:

7. …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

8. …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

9. …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

10. …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 Ophthalmology 1993; 100:

11. 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

12. 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:
Chuang , Lai Chi-Chun. Secondary intraocular lens implantation of traumatic cataract in open-globe injury. Can J Ophthalmol 2005;40:454–459