Pediatric Traumatic Cataracts: Insights From A Portuguese Cohort

Pediatric traumatic cataract is a permanent lens opacification resulting from ocular trauma, representing 12–46% of all pediatric cataracts. Ocular trauma is one of the leading causes of unilateral blindness in children, posing significant visual morbidity. Managing traumatic cataracts in this population is particularly challenging due to the risk of amblyopia, ongoing ocular growth, and the need for long-term follow-up. Early intervention is believed to be crucial to optimize visual outcomes. The aim of this study is to evaluate visual outcomes in pediatric traumatic cataract surgery.

Department of Ophthalmology, Hospitais da Universidade de Coimbra, ULS Coimbra, Coimbra, Portugal;

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal;

We conducted a retrospective observational study at a tertiary center in Portugal, including patients under 18 years of age with traumatic cataract who underwent cataract surgery in the last 15 years and had at least 2 months of follow-up. Collected data included age at trauma, gender, trauma type and cause, time between trauma and surgery, surgical technique, IOL implantation details, initial and final best corrected visual acuity (BCVA), and postoperative complications. Statistical analysis was performed using SPSS, with p-values <0.05 considered significant.

We included 20 eyes from 20 patients (80% male) with a mean age of 7.35 ± 3.91 years and a follow-up of 64.15 ± 45.79 months. Most traumas were penetrating (68.4%, n=13), while 31.6% (n=6) were blunt. Trauma type did not significantly affect final BCVA (p = 0.506). Mean BCVA improved from 2.03 ± 0.50 to 0.39 ± 0.88 logMAR post-surgery (p < 0.001). Corneal defects were observed in 65% (n=13), and prior repair had no significant impact (p > 0.05). Phacoemulsification was performed in 95% (n=19), with IOL implantation in all cases, mostly in the capsular bag (80%). Posterior capsulorhexis was performed in 65% (n=13), and anterior vitrectomy in 75% (n=15). Peditrica Ocular Trauma Score (POTS) predicted final visual acuity (β =-0.024, p<0.001).

This study demonstrates that, although traumatic ocular injuries are complex, pediatric cataract surgery results in improvements in visual acuity in a significant proportion of cases. The type of trauma and time between trauma and surgery were not significantly associated with final visual outcomes. POTS was found to be a significant predictor of final visual acuity, suggesting its potential role in assessing prognosis. Long-term follow-up is essential to monitor complications and optimize visual rehabilitation. Further studies are needed to confirm these findings.