Incidence, Clinical Profile and Prognostic Indicators for Visual Outcome in Traumatic Cataract Surgery in Yemen.
DOI:
https://doi.org/10.65693/j21umas.2025.v4i1.215الكلمات المفتاحية:
Traumatic Cataract, Ocular Morbidities, Cataract Surgery, Visual Outcome, Yemen.الملخص
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Background: Traumatic cataract is an important cause of monocular blindness. It poses a formidable challenge to ophthalmologists for achieving optimal visual acuity as visual prognosis shows highly unpredictability and the injured lens is not the only determining of visual outcome.
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Objective: The study was conducted to assess the incidence, clinical characteristics, and prognostic indicators for visual outcomes in traumatic cataract surgery.
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Methodology: Medical records of 832 patients presented with traumatic cataract and underwent surgical intervention during the study period at Magrabi Eye Hospital, Sana'a, Yemen were reviewed retrospectively. $\chi^{2}$ test, odds ratios, and 95% confidence intervals were used to figure out the prognostic factors for visual acuity $\ge6/18$ at final follow-up after cataract surgery.
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Results: The incidence rate of cataract was 0.78%, or 7.8, patients per 1000 patients of eye OPD. The mean age was $20.51\pm13.16$ SD years old with the majority (83.5%) $were\le30$ years old and $42.9\%<18$ years old. Males were 82.6%. Open globe injury was the most prevalent trauma type (70%). Cornea damage was the predominant concurrent injury in (58.2%). Anterior capsule rupture presented in 32.3% and was statistically indicator for presence in 46.7% of 122 eyes with posterior capsule rupture $(\chi^{2}=13.64, p=<0.001)$. Anterior surgical cataract removal approach performed in 61.4% and 38.6% performed pars plana vitrectomy with lensectomy (PPLV). Intraocular lens implanted 75.6%, with 89.5% placed at capsular bag. Posterior capsule opacity was the most late postoperative complication (8.3%). 47% of eyes achieved $\ge6/18$ and 27% were blind in the injured eye $<3/60$. Better initial visual acuity (VA) was statistically significant indicator for achieving final $VA\ge6/18$, $(\chi^{2}=29.4, p=<0.001)$. Correlation was found between final $VA\ge6/18$ and age and sex, female patients and younger than 18 years old had the best prognosis. Closed globe injury had satisfactory final $VA\ge6/18$ in 58% comparing to open globe injury 46.3%, $(\chi^{2}=8.944, p=0.003)$. Retinal detachment, endophthalmitis, vitreous hemorrhage, posterior capsule rupture or IOFB and no IOL implanted carried the poorest prognosis for final $VA\ge6/18$, $(p=<0.001)$. A statistically favorable final $VA\ge6/18$ was obtained in anterior approach cataract removal than PPLV $(\chi^{2}=102.3, p=<0.001)$, capsular bag IOL than non PCIOL $(\chi^{2}=11.5, p=<0.001)$ and primary IOL than secondary IOL implantation $(\chi^{2}=9.9, p=0.002)$. No difference was detected between simultaneous globe repair with cataract removal and two-step surgical procedure $(\chi=0.926, P=0.336)$. Posterior segment complications and significant corneal scaring were responsible for blind eyes $(<3/60)$ in 72% and 39.1% respectively, $(p=<0.001)$.
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Conclusion: Traumatic cataract remains a frequent sequel of ocular injuries with nearly one third of patients have monocular blindness with the overwhelming predominance of male, age group (1-30) years old, and open globe injury. About half of cases have a satisfactory vision after surgical intervention. The worst indicator factors for poor visual outcome are initial $VA\le1/60$, open globe injury, coexisting posterior segment pathology, posterior capsule rupture, and remained the eye aphakia.
المراجع
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الحقوق الفكرية (c) 2025 Hisham Alakhlee، Nabil Taresh Taresh، Mahfouth Bamashmus، Mohammed Al-Hemyari، Mahammed AlShekeil (المؤلف)
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