FIVE-YEAR INSIGHTS INTO VISUAL OUTCOMES AFTER TRAUMATIC CATARACT SURGERY AT A TERTIARY CENTER

We aim to evaluate the prognostic factors influencing final VA in surgically managed traumatic cataract patients in a tertiary referral center.

Academic University Hospital

A retrospective analysis was conducted on patients who underwent surgery for traumatic cataracts in Unidade Local de Saúde de Coimbra between January 2019 and August 2024. Demographics and clinical data were recorded. A multivariate analysis was performed to identify the prognostic factors of VA. The value of OTS predicting final VA was also calculated.

Fifty-one eyes (84.3% males; mean age of trauma 54.2± 18.7 years) of 51 patients were included. The most common cause of ocular trauma was blunt objects (47.1%). The initial mean VA of the patients was 1.6±0.8 (20/800) logMAR (Snellen) and the final mean best corrected visual acuity (BCVA) was 0.3±0.5 (20/63) logMAR (Snellen) (p <0.001). The mean OTS was 79.3 (±12.7) corresponding to rank 3. Zonular dialysis (43.1%), raised intraocular pressure (43.1%), and capsular defects (41.2%) were the most common associated findings. Regarding surgical technique, phacoemulsification was the most performed (52.9%, n=27), followed by phaco-aspiration (21.8%, n=11), and intracapsular extraction (21.8%, n=11). Our study found a significant correlation between final VA and surgery during the first week of trauma (r=0.352, p=0.019), pupilloplasty (r=0.434, p=0.003), raised intraocular pressure (r=0.313, p=0.36), and the need for reoperation (r=0.331, p=0.026). Additionally, final VA was adversely affected by the presence of intraocular foreign body (r=-0.342, p=0.021). No correlation was found between final VA and age of trauma, initial VA, types of surgery or intraocular lens (IOL) implantation, types of injuries, and OTS. After adjusting for confounding factors, the multivariate linear regression analysis showed no significant association with the final BCVA (p=0.172). The OTS reliably predicted final VA in most cases, except for OTS rank 3, where a significant difference was found between our study and the OTS prediction. In the overall, 82.2% (n=37) of patients achieved a final VA of 0.2 (20/32) logMAR (Snellen) or better.

Functional prognosis following ocular trauma varies widely, from no light perception to good vision according to the extension and type of trauma. Although some studies considered that initial VA can predict visual outcomes, our research did not find a significant correlation between initial and final VA. We attribute this to an extended follow-up period, low frequency of complications, types of trauma, and a low rate of posterior segment trauma (selection bias in this case series). In our study, early cataract surgery with IOL implantation significantly improved post-surgical BCVA. We also observed that OTS is not a reliable predictor of final visual outcome in category 3 of lenticular trauma. The large majority of patients achieved a satisfactory visual outcome.