Cataract Chaos: Unravelling The Complexities Of Pediatric Traumatic Cataract With Corneal Injury

We present a pedriatic patient who underwent primary closure of a temporary corneal woud after a short blunt trauma with a pencil, with subsecuent traumatic cataract associated trapped iris over the wound with anterior synechiae, dyscoric pupil, anterior capsule rupture

Clinica Oftalmologica COLSUBSIDIO, Bogotá DC, Colombia 

A 6-year-old patient was referred to the cornea service after primary closure of a corneal wound in the right eye (OD) 1 month ago, following blunt trauma with a pencil. Uncorrected visual acuity (AVSC) was finger count at 50 cm in OD and 20/25 in the left eye (OS). Biomicroscopy revealed a full-thickness corneal wound in zone I of OD, partially involving the visual axis, with sutures in place. The iris was trapped over the wound with anterior synechiae, dyscoric pupil, anterior capsule rupture, traumatic cataract, and phacodonesis. OS showed no alterations. Scheimpflug imaging showed hyperreflectivity in deep corneal layers, with a subluxated crystalline lens. Ocular ultrasound confirmed retina attachment with dense vitreous opacity and no foreign body. Pentacam revealed an irregular cornea with temporal leukoma, oblique astigmatism, high asphericity, and elevated anterior and posterior surfaces. The patient was evaluated by the retina service, and surgery was recommended to avoid amblyopia: phacoemulsification, capsulectomy, posterior vitrectomy, and inverted artisan retro-pupillary lens implantation. Lens calculation was performed using a pediatric IOL calculator. The procedure was completed without complications. Immediate post-op (POP) evaluation showed AVCC 20/400 in OD, with stable sutures and an air bubble in the anterior chamber. A follow-up at 10 and 45 days showed improved visual acuity of 20/25 in OD, with retina fully adhered.

This case emphasizes the importance of early intervention in managing pediatric traumatic cataracts, a major cause of preventable vision loss in developing countries. Children are particularly susceptible to these injuries due to limited motor skills, poor attention, and inadequate risk awareness. Treatment is complicated by ongoing eye growth and the risk of amblyopia. A lower Ocular Trauma System score and the need for additional surgeries were linked to worse final visual acuity. Visual outcomes depend on the extent of ocular damage and achieving proper rehabilitation. This case shows that timely surgery can improve visual acuity and prevent amblyopia, underscoring the need for a multidisciplinary approach.