bmj opentrauma is a cause of monocular blindness in the developed world, although few studies have...

For peer review only

Morphology of traumatic cataract: does it play role in final visual outcome? A hospital based cohort study

Journal: BMJ Open

Manuscript ID: BMJ Open.2011.000060

Article Type: Research

Date Submitted by the Author:

20-Jan-2011

Complete List of Authors: Shah, Mehul; Drashti Netralaya, Ophthalmology; Drashti Netralaya, Ophthalmology Shah, Shreya; Drashti Netralaya, Ophthalmology Shah, Shashank; Drashti Netralaya, Ophthalmology Patel, Chintan; Drashti Netralaya, Ophthalmology

Patel, Utsav; Drashti Netralaya, Ophthalmology

Subject Heading: Ophthalmology

Keywords: Cataract and refractive surgery < OPHTHALMOLOGY, Vetreoretinal < OPHTHALMOLOGY, Paediatric ophthalmology < OPHTHALMOLOGY

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

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Title: Morphology of traumatic cataract: does it play role in final visual outcome?

Short running head: Morphology of traumatic cataract.

Authors:

Name Degree E-mail

Dr. Mehul A. Shah

MD [email protected]

Dr Shreya M. Shah


Dr. Shashank B. Shah MBBS [email protected]

Dr. Chintan G. Patel MBBS [email protected]

Dr Utsav A. Patel MBBS [email protected]

Affiliations all authors:

Drashti Netralaya, Dahod, Gujarat, India

Address of corresponding author:

Drashti Netralaya,

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mailto:[email protected]





2

Nr. GIDC, Chakalia Road.

Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232

Email: [email protected]

• No financial support received from any company or institution

• This study is not presented at any conference or meeting

• Authors do not have any financial interest in any aspect of this study

Article Summery:

Aricle Focus:

Morphological Classification of traumatic cataract which may be helpful for guidelines of surgical technique.

Key Message:

Standardization of classification and treatment of traumatic cataract

Strength and weakness:

Strength: Larger database and Usage of stabdard classification method-BETTS Limitation: Included meny

neglected injury cases.

Contributor statement:

Mehul Shah: Conceptdesign study, surgeon, writing

Shreya Shah: Administrative support, writing, data analyses

Shashank Shah:Data collection, language editing

Chintan Patel: Data collection proof reading and editing

Utsav Patel: Data collection and editing

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Abstract:

Purpose: To provide evidence-based care to patients with traumatic cataract.

Setting: Tertiary eye care center –Dahod at the trijunction of Gujarat, Madhya Pradesh, and

Rajasthan states in central western India.

Methods: It is a Prospective cohort study All patients presented at our hospital with traumatic

cataracts between January 2003 and December 2009. All information regarding demographic

and ocular trauma was collected on a pre-tested World Eye Trauma Registry form for both the

first visit and follow-up.

In particular, we collected specific information about the morphology of traumatic cataracts;

surgical technique was determined accordingly.

Data were entered and analyzed with regard to the relationship between type of trauma and

resulting injury, results achieved with particular surgical techniques, and the relationship

between morphology and final visual outcome.

Outcome measures: Final visual outcome.

Results: Morphology of traumatic cataract made significant difference as far as final visual

outcome is concerned. (Table-5 χ 2 test, P = 0.014)

Conclusion: The morphology of traumatic cataract plays important roles in determining both the

appropriate surgical technique and final visual outcome.

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Introduction:

Trauma is a cause of monocular blindness in the developed world, although few studies

have addressed the problem of trauma in rural areas.1 The etiology of ocular injury in rural areas

is likely to differ from that in urban areas and is worthy of investigation.2-4

Any strategy for

prevention requires a knowledge of the cause of injury, which may enable more appropriate

targeting of resources toward preventing such injuries. Both eye trauma victims and society bear

a large, potentially preventable burden.3

Ocular trauma can cause cataracts.1 The methods used to evaluate the visual outcome in

eyes managed for traumatic cataracts and senile cataracts are similar,5 but the damage to other

ocular tissues due to trauma may compromise the visual gain in eyes operated on for traumatic

cataracts. Hence, the success rates may differ between eyes with these two types of cataract.

With the introduction of the Birmingham Eye Trauma Terminology System (BETTS),

the documentation of ocular trauma has been standardized.5

Our study was conducted in a city located at the intersection of the borders of three states

in India: Gujarat, Madhya Pradesh, and Rajasthan.11

Qualified ophthalmologists at our institute

provide low-cost eye services mainly to the poor belonging to the tribal population of 4.2 million

in this area.

There is no standard methodology for classification of traumatic cataract.

Patients and Methods:

We obtained approval from the hospital administrators and research committee to

conduct this study, and we received the participants’ written consent.

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This was a prospective study designed in 2002. All traumatic cataracts in either eye

diagnosed and managed between January 2003 and December 2009 were enrolled in our study,

and those consenting to participate and not having other serious body injuries were included.

For each patient enrolled in our study, we obtained a detailed history, including details of

the injury and information on eye treatment and surgery performed to manage past ocular

trauma. Data for both the initial and follow-up reports were collected using the online BETTS

format of the International Society of Ocular Trauma. Details of the surgery were also collected

using a specified pre-tested online form.

The cases of traumatic cataract were grouped as those with open- and those with closed-

globe injuries. The open-globe injuries were further categorized into those with lacerations and

those with rupture. Lacerations of the eyeball were subcategorized into eyes with perforating

injuries, penetrating injuries, or injuries involving an intraocular foreign body. The closed-globe

group was subdivided into lamellar laceration and contusion.

Other demographic details collected included patient entry, residence, activity at the time

of injury, object of injury, and previous examinations and treatments. After enrollment, all

patients were examined using a standard method. Visual acuity was checked using the Snellen

chart, and the anterior segment was examined using a slit lamp. Visual acuity in younger age

group was examined according guidelines of AAO vision check up in children.

Based on lenticular opacity, the cataracts were classified as total, when an examiner did

not observe clear lens matter between the capsule and nucleus, the cataract was defined as total.

(Figure 1), membranous, when the capsule and organized matter were fused and formed a

membrane of varying density, it was defined as a membranous cataract, in which both capsules

fused with scant or no cortical material (Figure 2), white soft cataract with ruptured capsule

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when loose cortical material was found in the anterior chamber together with a ruptured lens

capsule, the cataract was defined as white soft cataract with ruptured capsule. (Figure 3), and

rosette types A lens with a rosette pattern of opacity was classified as a rosette type cataract.

(Figure 4). We could cover all cataract cases presented to us under this classification.

Morphology mainly influenced by type, force, object of injury and time interval between injury

and examination.

For a partially opaque lens, the posterior segment examination was carried out with an indirect

ophthalmoscope and a +20 D lens. When the optical medium was not clear, a B-scan was

performed to evaluate the posterior segment.

The surgical technique was selected according to morphology and the condition of

tissues other than the lens. Phacoemulsification was used to operate on cataracts with hard, large

nuclei. With a lens that had either a white soft or rosette type of cataract, unimanual or bimanual

aspiration was used. Membranectomy and anterior vitrectomy, either via an anterior or pars

plana route, were performed when the cataract was membranous.

In all patients undergoing corneal wound repair, the traumatic cataract was managed in a

second procedure. Recurrent inflammation was more prominent in patients who had undergone

previous surgery for trauma.9, 10

in such cases, when ocular media found hazy due to

inflammation of the anterior vitreous, we performed a capsulectomy and vitrectomy via an

anterior/pars plana route in adults.

In children younger than 2 years of age, both lensectomy and vitrectomy via a pars plana

route was performed leaving rim of anterior capsule for secondary implant, and the same

surgical procedures were used to manage the traumatic cataract. Lens implantation as part of the

primary procedure was avoided in all children younger than 2 years of age.

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All patients with injuries and without an infection were treated with topical and systemic

corticosteroids and cycloplegics. The duration of medical treatment depended on the degree of

inflammation in the anterior and posterior segments of the operated eye. The operated patients

were re-examined after 24 h, 3 days, and 1, 2, and 6 weeks to enable refractive correction.

Follow-up was scheduled for the third day, weekly for 6 weeks, monthly for 3 months, and every

3 months for one year.

At every follow-up examination, visual acuity was tested using the Snellen chart and

vision in children checked with guidelines of AAO. The anterior segment was examined with a

slit lamp, and the posterior segment was examined with an indirect ophthalmoscope. Eyes with

vision better than 20/60 at the glasses appointment (6 weeks) were defined as having a

satisfactory grade of vision.

During the examination, data were entered online using a specified pretested format

designed by the International Society of Ocular Trauma (initial and follow-up forms), which was

exported to a Microsoft Excel spreadsheet. The data were audited periodically to ensure

completeness. We used the Statistical Package for Social Studies (SPSS 15) to analyze the data.

The univariate parametric method was used to calculate frequency, percentage, proportion, and

95% confidence interval (95% CI). We used binominal regression analysis to determine the

predictors of postoperative satisfactory vision (>20/60). The dependent variable was vision

>20/60 noted at the follow-up 6 weeks after cataract surgery. The independent variables were

age, gender, residence, time interval between injury and cataract surgery, primary posterior

capsulectomy and vitrectomy procedure, and type of ocular injury.

Results:

Our cohort consisted of 687 patients with traumatic cataracts (Figure 5) including 496 eyes with

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open-globe ocular injuries and 191 (27.8%) eyes with closed-globe injuries (Figure 5). The

patients were 492 (71.6%) males and 195 (28.4%) females. The mean patient age was 27.1 ±

18.54 years (range, 1–80).

We analyzed several demographic factors, including age (p=0.00), sex (p=0.340), patient

entry (p = 0.4) and socioeconomic status (79% were from lower socioeconomic class and

residence; 95% were from a rural area), and none had a significant relationship with final visual

acuity except age, according to cross tabulation and statistical tests. The object causing the

injury (p = 0.3) and the activity at the time of the injury (p = 0.3) were also not significantly

associated with satisfactory final visual acuity.

All traumatic cataracts were classified according to morphology (Tables 1 and 2) and

were surgically treated using morphology as a guideline. (Table-3)

The number of surgeries required varied significantly with morphology (p = 0.000)

(Table 4).

Final visual outcome was found to vary according to morphology and surgical technique.

White soft cataracts were found to have a better prognosis and achieved significantly higher

rates of positive outcome compared with other morphologies (p = 0.014) (Table 5).

We were able to do lens implants in 82% of cases; details are shown in Table-6.

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Discussion:

Using a large database, we attempted to systematically classify the morphology of

traumatic cataract and to select surgical techniques accordingly.

Various studies have touched on this topic. One study found 52.3% total cataracts,

whereas our results revealed 26.6% total cataracts 7.

Vajpayee reported an opening in the

posterior capsule with types 1 and 2 openings with penetrating injury 8, whereas we found

another membranous type of cataract (12.1%) suggestive of late reporting, as membranous

transformation of the lens with fusion of the anterior and posterior capsules may occur over

time.

We were able to perform intraocular lens implants in 82.1% of cases. Krishnamachary

reported implants in 65.5% cases, Churchill et al. reported implants in 46.8% cases, and

Fyodrove reported Sputnik implant in all cases7, 9, 10

.

Fyodrove reported surgical techniques according to pathology and degree of lens

absorption, but did not systematically classify similar factors taken into account in our study 10

.

These differences in findings may reflect the fact that of the 687 patients in our study,

30% came from outreach activities and did not approach treatment facilities on their own.

Therefore, the time period between ocular injury and reporting ranged widely, and morphology

was also influenced by this interval.

We propose a specific morphological classification for traumatic cataract, which may

provide guidelines for management that incorporate available technology and improve care for

these patients.

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The English in this document has been checked by at least two professional editors, both native

speakers of English. For a certificate, please see:

http://www.textcheck.com/certificate/wY0Ejf

References:

1. Khatry SK, Lewis AE, Schein OD, Thapa MD, Pradhan EK, Katz J, et al. The

epidemiology of ocular trauma in rural Nepal. Br J Ophthalmol. 2004; 88:456-60.

2. Abraham, D. I.; Vitale, S. I.; West, S. I.; Isseme, I. Epidemiology of eye injuries in rural

Tanzania. Ophthalmic Epidemiol.1999; 6:85-94

3. D. Virgil Alfaro, Eric P. Jablon, Monica Rodriguez Fontal, Simon J. Villalba, Robert

E.Morris, Michael Grossman, Enrique Roig-Melo et al. Fishing-related ocular trauma.

American Journal of Ophthalmology.2005; 139: 488-492

4. Shah M, Shah S, Khandekar R. Ocular injuries and visual status before and after Their

management in the tribal areas of Western India-A historical cohort study Grafes Arch

Clin Exp Ophthalmol 2008; 246:191–197.

5. Kuhn F, Morris R, Witherspoon CD, Mester V,) The Birmingham Eye Trauma

Terminology system (BETT). J Fr Ophtalmol. 2004; 27:206-10.

6. Vajpayee RB, Sharma N, Dada T, Gupta V, Kumar A, Dada VK. Management of

posterior capsule tears. Surv Ophthalmol 2001;45:473-88.

7. Krishnamachary M, Rathi V, Gupta S. Management of traumatic cataract in children. J

Cataract Refract Surg 1997;23 Suppl 1:681-7.

8. Churchill AJ, Noble BA, Etchells DE, George NJ. Factors affecting visual outcome in

children following uniocular traumatic cataract. Eye (Lond) 1995;9 ( Pt 3):285-91

9. Thylefors B, Chylack LT Jr, Konyama K, Sasaki K, Sperduto R, Taylor HR, et al. A simplified

cataract grading system. Ophthalmic Epidemiol. 2002; 9:83-95.

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10. Fyodorov SN, Egorova EV, Zubareva LN. 1004 cases of traumatic cataract surgery with

implantation of an intraocular lens. J Am Intraocul Implant Soc 1981;7:147-53.

Legends:

Fig-1: When no clear lens matter was visible between the capsule and the

nucleus, the cataract was defined as a total cataract..

Fig-2: When loose cortical material was found in the anterior chamber together

with a ruptured lens capsule, the cataract was defined as a white soft cataract

Fig-3: When the capsule and organized matter were fused and formed a

membrane of varying density, it was defined as a membranous cataract

Fig-4: A lens with a rosette pattern of opacity was classified as a rosette type

cataract.

Fig-5: Distribution of cataracts based on the ocular injuries, as per the BETTS

classification.

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Table 1. Distribution of different morphologies of traumatic cataract

Morphology N Percent

84 12.2

8

1.2

412

60.0

183 26.6

Membranous

Rosette

White soft

Total

Total 687 100.0

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Table 2. Morphology of traumatic cataract according to type of injury

Closed globe Open globe Total

20 64 84

3 5 8

83 329 412

Membranous

Rosette

Soft fluffy

Total

85 98 183

Total

191 496 687

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Table 3. Surgical techniques used according to morphology of cataract

Technique Morphology

Membranous Rosette White soft Total Total

7 5 316 19 347

46 0 60 20 126

3 2 17 108 130

Aspiration

Lensectomy +

Vitrectomy

Phaco/SICS

Delivery + vitrectomy 28 0 20 36 84

Total 83 7 412 183 687

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Table 4. Morphology of cataract in relation to number of surgical procedures

Morphology Total

Membranous Rosette White soft Total

70 6 349 159 584

12 2 58 22 94

2 0 5 2 9

1.00

2.00

3.00

Total 84 8 412 183 687

χ 2 test, P = 0.000

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Table 5. Final visual outcome in relation to morphology of cataract

Final visual outcome Morphology Total


2 0 10 5 17

24 2 88 57 171

12 0 26 18 56

7 1 32 24 64

21 1 90 33 145

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 4 160 42 223

Total 83 8 406 179 676

χ 2 test, P = 0.014

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Table 6. Lens implant in relation to morphology of traumatic cataract

Morphology No implant Implant Total

17 67 84

2 6 8

58 354 412

46 137 183

Membranous

Rosette

White soft

Total

Total 123 564 687

χ 2 test, p = 0.004

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Fig-1: When no clear lens matter was visible between the capsule and the nucleus, the cataract was defined as a total cataract. 203x160mm (96 x 96 DPI)

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Fig-2: When loose cortical material was found in the anterior chamber together with a ruptured lens capsule, the cataract was defined as a white soft cataract with ruptured anterior capsule.

91x106mm (96 x 96 DPI)

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Fig-3: When the capsule and organized matter were fused and formed a membrane of varying density, it was defined as a membranous cataract

26x22mm (96 x 96 DPI)

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Fig-4: A lens with a rosette pattern of opacity was classified as a rosette type cataract

74x78mm (96 x 96 DPI)

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Fig-5: Distribution of cataracts based on the ocular injuries, as per the BETTS classification. 188x190mm (96 x 96 DPI)

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STROBE 2007 (v4) checklist of items to be included in reports of observational studies in epidemiology*

Checklist for cohort, case-control, and cross-sectional studies (combined)

Section/Topic Item # Recommendation Reported on page #

(a) Indicate the study’s design with a commonly used term in the title or the abstract 4 Title and abstract 1

(b) Provide in the abstract an informative and balanced summary of what was done and what was found 4

Introduction

Background/rationale 2 Explain the scientific background and rationale for the investigation being reported 5

Objectives 3 State specific objectives, including any pre-specified hypotheses 5

Methods

Study design 4 Present key elements of study design early in the paper 6

Setting 5 Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data

collection 5,6

(a) Cohort study—Give the eligibility criteria, and the sources and methods of selection of participants. Describe

methods of follow-up

Case-control study—Give the eligibility criteria, and the sources and methods of case ascertainment and control

selection. Give the rationale for the choice of cases and controls

Cross-sectional study—Give the eligibility criteria, and the sources and methods of selection of participants

5,6 Participants 6

(b) Cohort study—For matched studies, give matching criteria and number of exposed and unexposed

Case-control study—For matched studies, give matching criteria and the number of controls per case

Variables 7 Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic

criteria, if applicable 6,7

Data sources/ measurement 8* For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe

comparability of assessment methods if there is more than one group 6,7,8

Bias 9 Describe any efforts to address potential sources of bias Nil

Study size 10 Explain how the study size was arrived at Time period

Quantitative variables 11 Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen

and why Morphology group

(a) Describe all statistical methods, including those used to control for confounding 7,8

(b) Describe any methods used to examine subgroups and interactions 7,8

(c) Explain how missing data were addressed Excluded

Statistical methods 12

(d) Cohort study—If applicable, explain how loss to follow-up was addressed

Case-control study—If applicable, explain how matching of cases and controls was addressed Follow up forms used

from ISOT

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Cross-sectional study—If applicable, describe analytical methods taking account of sampling strategy

(e) Describe any sensitivity analyses

Results

Participants 13* (a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility,

confirmed eligible, included in the study, completing follow-up, and analysed 9

(b) Give reasons for non-participation at each stage

(c) Consider use of a flow diagram Figure-5

Descriptive data 14* (a) Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and

potential confounders 9

(b) Indicate number of participants with missing data for each variable of interest 9

(c) Cohort study—Summarise follow-up time (eg, average and total amount) 9

Outcome data 15* Cohort study—Report numbers of outcome events or summary measures over time 9

Case-control study—Report numbers in each exposure category, or summary measures of exposure

Cross-sectional study—Report numbers of outcome events or summary measures

Main results 16 (a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95%

confidence interval). Make clear which confounders were adjusted for and why they were included 9 and tables

(b) Report category boundaries when continuous variables were categorized Tables

(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period Tables

Other analyses 17 Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses 9 and tables

Discussion

Key results 18 Summarise key results with reference to study objectives 10

Limitations 19 Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction

and magnitude of any potential bias 10

Interpretation 20 Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results

from similar studies, and other relevant evidence 10

Generalisability 21 Discuss the generalisability (external validity) of the study results 10

Other information 10

Funding 22 Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on

which the present article is based 1

*Give information separately for cases and controls in case-control studies and, if applicable, for exposed and unexposed groups in cohort and cross-sectional studies.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE

checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at

http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe-statement.org.

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Morphology of traumatic cataract: does it play role in final

visual outcome? A hospital based cohort study

Journal: BMJ Open

Manuscript ID: BMJ Open.2011.000060.R1



22-Feb-2011

Complete List of Authors: Shah, Mehul; Drashti Netralaya, Ophthalmology; Drashti Netralaya, Ophthalmology Shah, Shreya; Drashti Netralaya, Ophthalmology Shah, Shashank; Drashti Netralaya, Ophthalmology Patel, Chintan; Drashti Netralaya, Ophthalmology Patel, Utsav; Drashti Netralaya, Ophthalmology

Primary Subject

Heading: Ophthalmology



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Title: Morphology of traumatic cataract: does it play a role in final visual outcome?

Short running head: Morphology of traumatic cataract

Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah





Affiliations of all authors:



Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232


No financial support was received from any company or institution.

This study has not been presented at any conference or meeting.

The authors do not have any financial interests in any aspect of this study.

Conflicting interests: None to declare.

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Abstract:


Setting: Tertiary eye care centre in Dahod at the trijunction of Gujarat, Madhya Pradesh, and


Methods: This was a prospective cohort study among all patients presenting at our hospital with

traumatic cataracts between January 2003 and December 2009. All information regarding

demographic and ocular trauma was collected on a pre-tested World Eye Trauma Registry form

for both the first visit and follow-up.



Data were entered and analysed with regard to the relationship between type of trauma and




Results: Traumatic cataracts of different morphologies showed significant differences in final

visual outcome (χ2 test, P = 0.014).

Conclusion: The morphology of traumatic cataract plays an important role in determining both

the appropriate surgical technique and final visual outcome.

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Article Summery:

Article Focus:

Morphological Classification of traumatic cataract which may be helpful for guidelines of

surgical technique.

Key Message:

Standardization of classification and treatment of traumatic cataract


Strength: Larger database and Usage of standard classification method-BETTS Limitation:

Included many neglected injury cases. Weakness: Short follow up.

Introduction:


have addressed the problem of trauma in rural areas.1 The aetiology of ocular injury in rural

areas is likely to differ from that in urban areas and is worthy of investigation.2-4

Any strategy

for prevention requires knowledge of the cause of injury, which may enable more appropriate

targeting of resources toward preventing such injuries. Eye trauma represents a large, potentially

preventable burden on both victims and society as a whole.3



ocular tissues due to trauma may compromise the visual gain in eyes treated surgically for

traumatic cataracts. Hence, the success rates may differ between eyes with these two types of

cataract.

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the documentation of ocular trauma has been standardised.5





in this area.




conduct this study, and all participants provided written informed consent.


diagnosed and managed between January 2003 and December 2009 were included in the study,

and patients consenting to participate and without other serious body injuries were included.







globe injuries. The open-globe injuries were further categorised into those with lacerations and

those with rupture. Lacerations of the eyeball were subcategorised into eyes with perforating



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of injury, object of injury, and previous examinations and treatments. After enrolment, all

patients were examined using a standard method. Visual acuity was checked using a Snellen

chart, and the anterior segment was examined using a slit lamp.

Based on lenticular opacity, the cataracts were classified as total (Figure 1), membranous

in which both capsules fused with scant or no cortical material (Figure 2), white soft (Figure 3),

and rosette types (Figure 4). When an ophthalmologist did not observe clear lens matter between

the capsule and nucleus, the cataract was defined as total. When the capsule and organised

matter were fused and formed a membrane of varying density, it was defined as a membranous

cataract. When loose cortical material was found in the anterior chamber together with a

ruptured lens capsule, the cataract was defined as white soft. A lens with a rosette pattern of

opacity was classified as a rosette type cataract.

For a partially opaque lens, the posterior segment examination was carried out with an

indirect ophthalmoscope and a +20 D lens. When the optical medium was not clear, a B-scan

was performed to evaluate the posterior segment.


tissues other than the lens. Phacoemulsification was used to treat cataracts with hard, large


aspiration was used. Membranectomy and anterior vitrectomy, via either the anterior or pars




previous surgery for trauma.9,10

In these cases, the ocular medium may become hazy owing to

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condensation of the anterior vitreous unless a vitrectomy is performed. Hence, we performed a

capsulectomy and vitrectomy via the anterior/pars plana route in adults.

In children younger than 2 years of age, both a lensectomy and vitrectomy via the pars

plana route were performed, and the same surgical procedures were used to manage the

traumatic cataract, with secondary implants done as a separate procedure after the age of 2 years.

Lens implantation as part of the primary procedure was avoided in all children younger than 2

years of age. All children were evaluated for amblyopia and were treated with the aid of

paediatric ophthalmologists and paediatric optometrists.

All patients with injuries and without infection were treated with topical and systemic





3 months for 1 year.

At all follow-up examinations, visual acuity was tested using a Snellen chart. The

anterior segment was examined with a slit lamp, and the posterior segment was examined with

an indirect ophthalmoscope. Eyes with vision better than 20/60 at the glasses appointment (6

weeks) were defined as having a satisfactory grade of vision.

During the examination, data were entered online using a specified pre-tested format



completeness. We used SPSS 15 software to analyse the data. The univariate parametric method

was used to calculate frequency, percentage, proportion, and 95% confidence interval (95% CI).

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We used binominal regression analysis to determine the predictors of postoperative satisfactory

vision (> 20/60). The dependent variable was vision >20/60 noted at follow-up 6 weeks after

cataract surgery. The independent variables were age, gender, residence, time interval between

injury and cataract surgery, primary posterior capsulectomy and vitrectomy procedure, and type

of ocular injury.

Results:

Our cohort consisted of 687 (72.2) patients with traumatic cataracts (Figure 5), including 496

eyes with open-globe ocular injuries and 191 (27.8%) eyes with closed-globe injuries (Figure 5).

The patients were 492 (71.6%) males and 195 (28.4%) females. The mean patient age was

27.1 ± 18.54 years (range, 1–80).

We analysed several demographic factors, including gender (P = 0.340), patient entry

(P = 0.4), and socioeconomic status (79% were from lower socioeconomic class and residence;

95% were from rural areas). None of these showed a significant relationship with final visual

acuity, according to cross-tabulation and statistical tests. The object causing the injury (P = 0.3)

and the activity at the time of the injury (P = 0.3) were also not significantly associated with

satisfactory final visual acuity. A significant relationship was found between age and final visual

outcome (P = 0.000). There was no significant difference in final visual outcome in children

between open and closed injury groups (P = 0.06).


were surgically treated using morphology as a guideline. (Table 3)

The number of surgeries required varied significantly with morphology (P = 0.000)

(Table 4).

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White soft cataracts had a better prognosis and achieved significantly higher rates of positive

outcome compared with other morphologies (P = 0.014) (Table 5).

Lens implants were applied in 82% of the cases; the details are shown in Table 6. There

was a significant difference between open and closed injury groups for various age groups (P =

0.000).

Discussion:



Previous studies have touched on this topic. One study found 52.3% total cataracts,

whereas our results revealed 26.6% total cataracts.7 Vajpayee reported opening in the posterior

capsule with type 1 and 2 openings with penetrating injury,8 whereas we found another

membranous type of cataract (12.1%) suggestive of late reporting, as membranous


time.

We were able to perform intraocular lens implants in 82.1% of the cases.

Krishnamachary reported implants in 65.5% of cases, Churchill et al. reported implants in

46.8%, and Fyodrove reported Sputnik implants in all cases.7,9,10

Fyodrove reported surgical techniques according to pathology and degree of lens

absorption, but did not systematically classify similar factors taken into account in our study.10



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these patients.

References:















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Table 1. Distribution of traumatic cataract morphologies

Morphology N Percentage

Membranous 84 12.2

Rosette 8 1.2

Soft material 412 60.0

Capsular rupture 183 26.6

Total 687 100.0

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Table 2. Morphology of traumatic cataracts according to type of injury

Morphology Closed globe

injury

Open globe

injury

Total

Membranous 20 64 84

Rosette

3 5

8

Soft fluffy

83 329

412

Total 85 98 183

Total 191 496 687

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Technique Morphology


7 5 316 19 347

46 0 60 20 126

3 2 17 108 130

Aspiration

Lensectomy +

Vitrectomy

Phaco/SICS

Delivery + vitrectomy 28 0 20 36 84

Total 83 7 412 183 687

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Morphology Total

No. Membranous Rosette White soft Total

1 70 6 349 159 584

2 12 2 58 22 94

3 2 0 5 2 9

Total 84 8 412 183 687

χ2 test, P = 0.000


Final visual outcome Morphology Total


3 0 11 5 19

24 2 89 58 173

12 0 27 19 58

7 1 33 25 66

21 1 91 34 147

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 4 161 42 224

Total 83 7 412 183 687

χ2 test, P = 0.014

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Membranous 17 67 84

Rosette 2 6 8

White soft 58 354 412

Total 46 137 183

Total 123 564 687

χ2 test, P = 0.004

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Table 7. Comparison of open and closed globe injuries in children

Category Closed

globe

Open

globe Total

Paediatric 53 253 306

Adult 137 243 380

Total 190 496 686

P = 0.000

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Figure Legends:

Fig. 1: When no clear lens matter was visible between the capsule and the nucleus, the cataract

was defined as a total cataract.

Fig. 2: When loose cortical material was found in the anterior chamber together with a ruptured

lens capsule, the cataract was defined as a white soft cataract.

Fig. 3: When the capsule and organised matter were fused and formed a membrane of varying

density, the cataract was defined as a membranous cataract.

Fig. 4: A lens with a rosette pattern of opacity was classified as a rosette type cataract.

Fig. 5: Distribution of cataracts based on the ocular injury, as per the BETTS classification.

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The English in this document has been checked by at least two professional editors, both native speakers

of English. For a certificate, please see:

http://www.textcheck.com/certificate/rbgCMs

Contributor ship Statement:

Mehul Shah: Concept design study, surgeon, writing


Shashank Shah: Data collection, language editing



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Introduction



Methods



collection 5,6






5,6 Participants 6

















from ISOT

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Results

















Discussion














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Journal: BMJ Open




03-Apr-2011


Primary Subject




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Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah








Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232






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Abstract:




Methods: This was a retrospective observational cohort study among all patients presenting at

our hospital with traumatic cataracts between January 2003 and December 2009. All information

regarding demographic and ocular trauma was collected on a pre-tested World Eye Trauma

Registry form for both the first visit and follow-up.











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Article Summery:

Article Focus:


surgical technique.

Key Message:

Proposal of new classification which may suggest surgical treatment of traumatic cataract




Introduction:




Any strategy








cataract.

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in this area.


















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of ocular injury.

Results:




27.1 ± 18.54 years (range, 1–80).












(Table 4).

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0.000).

Discussion:








time.



46.8%, and Fyodorov reported Sputnik implants in all cases.7,9,10

Fyodorov reported surgical techniques according to pathology and degree of lens




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these patients.

References:















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84 12.2

8

1.2

412

60.0

183 26.6

Membranous

Rosette

White soft

Total

Total 687 100.0

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BETT Category Closed globe Open globe Total

Morphology N % N % N %

20 2.9 64 9.3 84 12.2

3 0.4 5 0.7 8 1.1

83 12.1 329 47.9 412 59.9

Membranous

Rosette

White Soft with ruptured

Anterior capsule

Total

85 12.4 98 14.3 183 26.6

Total

191 27.8 496 72.2 687 100

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Morphology


Total

Surgical Technique

N % N % N % N % N %

7 1 5 0.7 316 45.9 19 2.7 347 50.5

46 6.7 0 0 60 8.7 20 2.9 126 18.3

3 0.4 2 0.3 17 2.4 108 15.7 130 18.9

Aspiration

Lensectomy + Vitrectomy

Phaco/SICS*

Delivery + vitrectomy

28 4 0 0 20 2.9 36 5.2 84 12.2

Total 83 12.1 7 1 412 59.9 183 26.6 687 100

*Small Incision Cataract Surgery

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Morphology


N N % N % N % N % N &

70 10.1 6 0.8 349 50.8 159 23.1 584 85.0

12 1.7 2 0.2 58 8.4 22 3.2 94 13.7

2 0.3 0 0 5 0.7 2 0.2 9 1.3

1.00

2.00

3.00

Total 84 12.2 8 1 412 59.9 183 26.6 687 100

χ 2 test, P = 0.000

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Final visual outcome Morphology


N % N % N % N % N %

3 0.4 0 0 11 1.6 5 0.7 19 2.7

24 3.5 2 0.3 89 12.9 58 8.4 173 25.1

12 1.7 0 0 27 3.9 19 2.7 58 8.4

7 1.0 1 0.1 33 4.8 25 3.6 66 9.6

21 3.0 1 0.1 91 13.2 34 4.9 147 21.4

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 2.5 4 0.5 161 23.4 42 6.1 224 32.6

Total 83 12.1 7 1.0 412 59.9 183 26.6 687 100

χ 2 test, P = 0.014

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N % N % N %

17 2.5 67 9.8 84 12.2

2 0.3 6 0.9 8 1.2

58 8.4 354 51.5 412 60.0

46 6.7 137 19.9 183 26.6

Membranous

Rosette

White soft

Total

Total 123 17.9 564 82.1 687 100

χ 2 test, p = 0.004

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Table-7. Comparison of open closed globe injuries in children

Category Closed globe Open globe Total

N % N % N %

54 7.7 253 36.8 307 44.7 Pediatric

Adult 137 19.9 243 35.3 380 55.3

Total 191 27.8 496 72.1 687 100

χ 2 test, p=0.000

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Figure Legends:









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Introduction



Methods



collection 5,6






5,6 Participants 6

















from ISOT

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Results

















Discussion














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Journal: BMJ Open




07-Apr-2011


Primary Subject




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Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah








Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232






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Abstract:




Methods: This was a retrospective observational cohort study among all patients presenting at

our hospital with traumatic cataracts between January 2003 and December 2009. All information













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Article Summery:

Article Focus:


surgical technique.

Key Message:





Introduction:




Any strategy








cataract.

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in this area.


















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8





of ocular injury.

Results:




27.1 ± 18.54 years (range, 1–80).












(Table 4).

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0.000).

Discussion:








time.








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these patients.

References:















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84 12.2

8

1.2

412

60.0

183 26.6

Membranous

Rosette

White soft

Total

Total 687 100.0

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20 2.9 64 9.3 84 12.2

3 0.4 5 0.7 8 1.1

83 12.1 329 47.9 412 59.9

Membranous

Rosette


Anterior capsule

Total

85 12.4 98 14.3 183 26.6

Total

191 27.8 496 72.2 687 100

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Morphology


Total

Surgical Technique

N % N % N % N % N %

7 1 5 0.7 316 45.9 19 2.7 347 50.5

46 6.7 0 0 60 8.7 20 2.9 126 18.3

3 0.4 2 0.3 17 2.4 108 15.7 130 18.9

Aspiration


Phaco/SICS*


28 4 0 0 20 2.9 36 5.2 84 12.2

Total 83 12.1 7 1 412 59.9 183 26.6 687 100


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Morphology


N N % N % N % N % N &

70 10.1 6 0.8 349 50.8 159 23.1 584 85.0

12 1.7 2 0.2 58 8.4 22 3.2 94 13.7

2 0.3 0 0 5 0.7 2 0.2 9 1.3

1.00

2.00

3.00

Total 84 12.2 8 1 412 59.9 183 26.6 687 100

χ 2 test, P = 0.000

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N % N % N % N % N %

3 0.4 0 0 11 1.6 5 0.7 19 2.7

24 3.5 2 0.3 89 12.9 58 8.4 173 25.1

12 1.7 0 0 27 3.9 19 2.7 58 8.4

7 1.0 1 0.1 33 4.8 25 3.6 66 9.6

21 3.0 1 0.1 91 13.2 34 4.9 147 21.4

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 2.5 4 0.5 161 23.4 42 6.1 224 32.6

Total 83 12.1 7 1.0 412 59.9 183 26.6 687 100

χ 2 test, P = 0.014

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N % N % N %

17 2.5 67 9.8 84 12.2

2 0.3 6 0.9 8 1.2

58 8.4 354 51.5 412 60.0

46 6.7 137 19.9 183 26.6

Membranous

Rosette

White soft

Total

Total 123 17.9 564 82.1 687 100

χ 2 test, p = 0.004

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N % N % N %

54 7.7 253 36.8 307 44.7 Pediatric

Adult 137 19.9 243 35.3 380 55.3

Total 191 27.8 496 72.1 687 100

χ 2 test, p=0.000

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Figure Legends:









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Journal: BMJ Open




15-Apr-2011


Primary Subject




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jopen.bmj.com

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Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah








Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232






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Abstract:




Methods: This was a prospective observational cohort study among all patients presenting at our

hospital with traumatic cataracts between January 2003 and December 2009. All information













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Article Summery:

Article Focus:


surgical technique.

Key Message:




Included many neglected injury cases. Weakness: Short follow up. Loss of follow up of 12

patients at various stages of study.

Introduction:




Any strategy







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cataract.







in this area.
















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of ocular injury.

Results:




27.1 ± 18.54 years (range, 1–80).






satisfactory final visual acuityAll traumatic cataracts were classified according to morphology

(Tables 1 and 2) and were surgically treated using morphology as a guideline. (Table 3)


(Table 4).

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0.000).

There was no significant difference in final visual outcome in children between open

and closed injury groups (P = 0.06). Significant difference found if we compare final visual

outcome before and after treatment. (P=000)Table-8 A significant relationship was found

between age and final visual outcome (P = 0.000) final visual outcome is better in younger age

group. (Table-9)

Discussion:








time.




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these patients.

References:











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84 12.2

8

1.2

412

60.0

183 26.6

Membranous

Rosette

White soft

Total

Total 687 100.0

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20 2.9 64 9.3 84 12.2

3 0.4 5 0.7 8 1.1

83 12.1 329 47.9 412 59.9

Membranous

Rosette


Anterior capsule

Total

85 12.4 98 14.3 183 26.6

Total

191 27.8 496 72.2 687 100

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Morphology


Total

Surgical Technique

N % N % N % N % N %

7 1 5 0.7 316 45.9 19 2.7 347 50.5

46 6.7 0 0 60 8.7 20 2.9 126 18.3

3 0.4 2 0.3 17 2.4 108 15.7 130 18.9

Aspiration


Phaco/SICS*


28 4 0 0 20 2.9 36 5.2 84 12.2

Total 83 12.1 7 1 412 59.9 183 26.6 687 100


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Morphology


N N % N % N % N % N &

70 10.1 6 0.8 349 50.8 159 23.1 584 85.0

12 1.7 2 0.2 58 8.4 22 3.2 94 13.7

2 0.3 0 0 5 0.7 2 0.2 9 1.3

1.00

2.00

3.00

Total 84 12.2 8 1 412 59.9 183 26.6 687 100

χ 2 test, P = 0.000

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N % N % N % N % N %

3 0.4 0 0 11 1.6 5 0.7 19 2.7

24 3.5 2 0.3 89 12.9 58 8.4 173 25.1

12 1.7 0 0 27 3.9 19 2.7 58 8.4

7 1.0 1 0.1 33 4.8 25 3.6 66 9.6

21 3.0 1 0.1 91 13.2 34 4.9 147 21.4

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 2.5 4 0.5 161 23.4 42 6.1 224 32.6

Total 83 12.1 7 1.0 412 59.9 183 26.6 687 100

χ 2 test, P = 0.014

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N % N % N %

17 2.5 67 9.8 84 12.2

2 0.3 6 0.9 8 1.2

58 8.4 354 51.5 412 60.0

46 6.7 137 19.9 183 26.6

Membranous

Rosette

White soft

Total

Total 123 17.9 564 82.1 687 100

χ 2 test, p = 0.004

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N % N % N %

54 7.7 253 36.8 307 44.7 Pediatric

Adult 137 19.9 243 35.3 380 55.3

Total 191 27.8 496 72.1 687 100

χ 2 test, p=0.000

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Table-8, Comparative visual acuity before and after treatment

Post treatment vision Pre op vision uncooperative <1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20 /60

20/40 to 20/20

Total E

uncooperative 7 1.01 0 0 0 0 0 0 1 0.14 2 0.29 10 1.45

<1/60

10 1.45 164 23.87 53 7.71 54 7.86 110 16.01 191 27.80 582 84.71

1/60 to 3/60

0 0 4 0.58 3 0.43 8 1.16 21 3.05 10 1.45 46 6.69

6/60 to 6/36

0 0 0 0 0 0 1 0.14 7 1.01 12 1.74 20 2.91

6/24 to 6/18

0 0 3 0.43 0 0 1 0.14 6 0.87 7 1.01 17 2.47

6/12 to 6/6

0 0 0 0 0 0 0 0 0 0 1 0.14 1 0.14

Total 17 2.47 171 24.89 55 8.00 64 9.31 145 21.10 223 32.45 675 98.5

χ 2 test, p=0.000

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Table-9, Effect age group on final visual outcome.

Age Un

cooperative <1/60 1/60 to

3/60 20/200 to

20/120 20/80 to

20/60 20/40 to

20/20 Total

n % n % n % n % n % n % n %

0 to 10 9 1.31 46 6.69 15 2.18 12 1.74 37 5.38 34 4.94 153 22.27

11 to 20

2 0.29 30 4.36 14 2.03 17 2.47 33 4.80 87 12.66 183 26.63

21 to 30

2 0.29 19 2.76 8 1.16 6 0.87 12 1.74 42 6.11 89 12.95

31 to 40

1 0.14 23 3.35 5 0.73 7 1.01 16 2.32 25 3.63 77 11.2

41 to 50

3 0.43 23 3.35 6 0.87 12 1.74 28 4.07 22 3.20 94 13.68

51 to 60

0 0.0 21 3.00 7 1.01 6 0.87 8 1.16 11 1.60 53 7.71

61 to 70

0 0.0 8 1.16 0 0 2 0.29 10 1.45 2 0.29 22 3.20

71 to 80

0 0.0 1 0.14 0 0 2 0.29 1 0.14 0 0 4 0.58

Total 17 2.47 173 25.18 55 8.00 64 9.31 146 21.25 223 32.45 675 98.5

χ 2 test, p=0.000

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Figure Legends:









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Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah








Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232






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Abstract:

Purpose: To study morphology of traumatic cataract as a important predictor for final visual

outcome after treatment of traumatic cataracts.















Conclusion: The morphology of traumatic cataract plays an important role in final visual

outcome.

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Article Summery:

Article Focus:


surgical technique.

Key Message:




Included many neglected injury cases. Weakness: Short follow up. Loss of follow up of 12

patients at various stages of study.

Introduction:




Any strategy






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cataract.







in this area.















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of ocular injury.

Results:




27.1 ± 18.54 years (range, 1–80).









(Table 4).

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0.000).





group. (Table-9) When time interval between injury and intervention was study there is

significant (p=0.000) effect on final visual outcome.11

Discussion:








time.

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these patients.

References:





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11. Shah MA, Shah SM, Shah SB, Patel UA Effect of interval between time of injury and

timing of intervention on final visual outcome in cases of traumatic cataract. Eur J

Ophthalmol. 2011 Mar 24. pii: 338AC21D-E9FB-42DF-9C28-6FDE61928C9D. doi:

10.5301/EJO.2011.6482. [Epub ahead of print]

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http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shah%20MA%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shah%20SM%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shah%20SB%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Patel%20UA%22%5BAuthor%5D



12



84 12.2

8

1.2

Membranous

Rosette

White soft

412

60.0

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183 26.6

Total

Total 687 100.0




Membranous

20 2.9 64 9.3 84 12.2

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3 0.4 5 0.7 8 1.1

83 12.1 329 47.9 412 59.9

Rosette


Anterior capsule

Total

85 12.4 98 14.3 183 26.6

Total

191 27.8 496 72.2 687 100

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Morphology


Total

Surgical Technique

N % N % N % N % N %

7 1 5 0.7 316 45.9 19 2.7 347 50.5

46 6.7 0 0 60 8.7 20 2.9 126 18.3

3 0.4 2 0.3 17 2.4 108 15.7 130 18.9

Aspiration


Phaco/SICS*


28 4 0 0 20 2.9 36 5.2 84 12.2

Total 83 12.1 7 1 412 59.9 183 26.6 687 100


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Morphology


N N % N % N % N % N &

70 10.1 6 0.8 349 50.8 159 23.1 584 85.0

12 1.7 2 0.2 58 8.4 22 3.2 94 13.7

2 0.3 0 0 5 0.7 2 0.2 9 1.3

1.00

2.00

3.00

Total 84 12.2 8 1 412 59.9 183 26.6 687 100

χ 2 test, P = 0.000

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N % N % N % N % N %

3 0.4 0 0 11 1.6 5 0.7 19 2.7

24 3.5 2 0.3 89 12.9 58 8.4 173 25.1

12 1.7 0 0 27 3.9 19 2.7 58 8.4

7 1.0 1 0.1 33 4.8 25 3.6 66 9.6

21 3.0 1 0.1 91 13.2 34 4.9 147 21.4

Uncooperative

<1/60

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

20/40 to 20/20 17 2.5 4 0.5 161 23.4 42 6.1 224 32.6

Total 83 12.1 7 1.0 412 59.9 183 26.6 687 100

χ 2 test, P = 0.014

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N % N % N %

17 2.5 67 9.8 84 12.2

2 0.3 6 0.9 8 1.2

58 8.4 354 51.5 412 60.0

46 6.7 137 19.9 183 26.6

Membranous

Rosette

White soft

Total

Total 123 17.9 564 82.1 687 100

χ 2 test, p = 0.004

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N % N % N %

54 7.7 253 36.8 307 44.7 Pediatric

Adult 137 19.9 243 35.3 380 55.3

Total 191 27.8 496 72.1 687 100

χ 2 test, p=0.000

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1/60 to 3/60

20/200 to 20/120

20/80 to 20 /60

20/40 to 20/20

Total E

uncooperative 7 1.01 0 0 0 0 0 0 1 0.14 2 0.29 10 1.45

<1/60

10 1.45 164 23.87 53 7.71 54 7.86 110 16.01 191 27.80 582 84.71

1/60 to 3/60

0 0 4 0.58 3 0.43 8 1.16 21 3.05 10 1.45 46 6.69

6/60 to 6/36

0 0 0 0 0 0 1 0.14 7 1.01 12 1.74 20 2.91

6/24 to 6/18

0 0 3 0.43 0 0 1 0.14 6 0.87 7 1.01 17 2.47

6/12 to 6/6

0 0 0 0 0 0 0 0 0 0 1 0.14 1 0.14

Total 17 2.47 171 24.89 55 8.00 64 9.31 145 21.10 223 32.45 675 98.5

χ 2 test, p=0.000

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Age Un


3/60 20/200 to

20/120 20/80 to

20/60 20/40 to

20/20 Total

n % n % n % n % n % n % n %

0 to 10 9 1.31 46 6.69 15 2.18 12 1.74 37 5.38 34 4.94 153 22.27

11 to 20

2 0.29 30 4.36 14 2.03 17 2.47 33 4.80 87 12.66 183 26.63

21 to 30

2 0.29 19 2.76 8 1.16 6 0.87 12 1.74 42 6.11 89 12.95

31 to 40

1 0.14 23 3.35 5 0.73 7 1.01 16 2.32 25 3.63 77 11.2

41 to 50

3 0.43 23 3.35 6 0.87 12 1.74 28 4.07 22 3.20 94 13.68

51 to 60

0 0.0 21 3.00 7 1.01 6 0.87 8 1.16 11 1.60 53 7.71

61 to 70

0 0.0 8 1.16 0 0 2 0.29 10 1.45 2 0.29 22 3.20

71 to 80

0 0.0 1 0.14 0 0 2 0.29 1 0.14 0 0 4 0.58

Total 17 2.47 173 25.18 55 8.00 64 9.31 146 21.25 223 32.45 675 98.5

χ 2 test, p=0.000

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Figure Legends:









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Aashish Gupta: Editing revisions

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Authors:

Name Degree E-mail

Dr. Mehul A. Shah


Dr Shreya M. Shah








Drashti Netralaya,


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Dahod-389151

Gujarat

Ph: 00-91-2673-645364 Fax: 00-91-2673-221232






This research received no specific grant from any funding agency in the public, commercial or

not-for-profit sectors’

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Abstract:

















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outcome.

Article Summery:

Article Focus:


surgical technique.

Key Message:

Proposal of new guidelines of surgical treatment of traumatic cataract for different morphologies of

traumatic cataract."



Included many neglected injury cases.

Weakness: Uncontrolled study, One third enrolment from outreach limits generalization of

findings,Short follow up. Loss of follow up of 12 patients at various stages of study.

Introduction:

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Any strategy








cataract.







in this area.







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Outreach activities included five different service deliveries mobile diagnostic camps, school

screening, mobile vision center, door to door call of patients and health worker network.





















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of ocular injury.

Results:




27.1 ± 18.54 years (range, 1–80).

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(Table 4).






0.000).







Discussion:

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time.









was also influenced by this interval. While this uncontrolled study cannot provide firm evidence

that using a clear morphological classification to guide surgical decision led to improved

outcomes.

We propose a specific treatment strategy for different morphological verities of

traumatic cataract, which may provide guidelines for management that incorporate available

technology and improve care for these patients.

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References:

1. Khatry SK, Lewis AE, Schein OD et al. The epidemiology of ocular trauma in rural

Nepal. Br J Ophthalmol. 2004; 88:456-60.

2. Abraham, DI; Vitale SI; West SI et al. Epidemiology of eye injuries in rural Tanzania.

Ophthalmic Epidemiol.1999; 6:85-94

3. D. Virgil Alfaro, Eric P. Jablon, Monica Rodriguez Fontal et al. Fishing-related ocular

trauma. American Journal of Ophthalmology.2005; 139: 488-492




5. Kuhn F, Morris R, Witherspoon CD et al. The Birmingham Eye Trauma Terminology

system (BETT). J Fr Ophtalmol. 2004; 27:206-10.

6. Vajpayee RB, Sharma N, Dada T et al. Management of posterior capsule tears. Surv

Ophthalmol 2001;45:473-88.


Cataract Refract Surg 1997;23 :681-7.

8. Churchill AJ, Noble BA, Etchells DE et al. Factors affecting visual outcome in children

following uniocular traumatic cataract. Eye (Lond) 1995;9:285-91

9. Thylefors B, Chylack LT Jr, Konyama K, et al. A simplified cataract grading system.

Ophthalmic Epidemiol. 2002; 9:83-95.



11. Shah MA, Shah SM, Shah SB, et al Effect of interval between time of injury and timing

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of intervention on final visual outcome in cases of traumatic cataract. Eur J Ophthalmol.

2011 Mar 24. pii: 338AC21D-E9FB-42DF-9C28-6FDE61928C9D. doi:



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84 12.2

8

1.2

412

60.0

183 26.6

Membranous

Rosette

White soft

Total

Total 687 100.0


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20 2.9 64 9.3 84 12.2

3 0.4 5 0.7 8 1.1

83 12.1 329 47.9 412 59.9

Membranous

Rosette


Anterior capsule

Total

85 12.4 98 14.3 183 26.6

Total

191 27.8 496 72.2 687 100

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