Ocular Trauma Score, Surgery Predicts Vision in Children With Traumatic Cataract

A low ocular trauma score and additional surgeries are prognostic factors for poor final visual acuity among pediatric patients with traumatic cataracts, according to a study published in Injury.

Researchers retroscopically reviewed and compared the medical records of 36 individuals who underwent surgery for traumatic cataracts consisting of an adult (n=18; mean age, 47.8 years; men, 16) and pediatric (n=18; mean age, 9.4 years; boys, 12) cohort. Data collection included demographics (age and gender), nature of trauma (cause and zone), visual acuity, clinical findings, and the presence of ocular pathologies such as uveal tissue prolapse, hyphema, vitreous loss, vitreous hemorrhage, and retinal detachment. 

The injury location was assigned a zone and classified according to the Ocular Trauma Classification System guidelines. These included injuries to the cornea and corneoscleral limbus (zone 1), corneoscleral limbus at a point 5 mm posterior to the sclera (zone 2), and sclera at a point more than 5 mm to the corneoscleral limbus (zone 3). 

Ocular Trauma Score (OTS) was calculated after evaluating rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect, and initial VA for each patient. 

According to the report, the most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. Zone 1 trauma was most common among both children (56%) and adults (61%). 

The presenting mean [SD] VA was 0.03 [0.09] among the pediatric cohort and 0.09 [0.1] among adult participants which worsened to 0.39 in children and 0.37 in adults at 3 months following surgery. The mean [SD] OTS was 51.4 [16.4] and 59.6 [10.5] in the pediatric and adult groups, respectively. Final VA was correlated with OTS in both groups and the presence of additional surgery in the pediatric group.

Investigators emphasize the importance of understanding ocular pathologies and methods of injury among pediatric patients with traumatic cataracts. “Surgical approach and optimal timing are very important and challenging in pediatric patients,” according to the study authors. “Management for pediatric traumatic cataracts vary depending on the associated ocular injuries and the patients’ age.”

Study limitations include a small sample size, an overrepresentation of men and boys in the study samples, and the exclusion of young children who could not describe their vision.