Predicting Visual Recovery In Traumatic Cataracts: Analysis Of 100 Cases

Ocular trauma is an important cause of unilateral visual impairment and blindness worldwide. Among its complications, traumatic cataracts occur in up to 65% of cases. Compared to age-related cataracts, traumatic cataracts pose unique surgical challenges due to associated complications such as capsular rupture, zonular instability, synechiae, iris damage, and corneal scarring. The Ocular Trauma Score (OTS) is a widely used prognostic tool for visual outcomes after ocular injuries. While recent research suggests that OTS predicts final visual acuity, its applicability to traumatic cataracts remains insufficiently studied. This study aims to identify key determinants of final VA and validate the predictive value of OTS in lenticular trauma.

A retrospective analysis was performed on patients who underwent surgery for traumatic cataracts at the Centro Hospitalar Universitário de Coimbra, Unidade Local de Saúde de Coimbra, between January 2014 and December 2024. 

Data on demographics, clinical characteristics, trauma details including intraocular foreign bodies (IOFB), preoperative ocular status, and surgical outcomes were systematically collected. The Pearson correlation test was used to assess relationships between pairs of variables. To identify independent predictors of best-corrected visual acuity (BCVA) at the final follow-up, a forward stepwise multiple regression analysis was conducted. Additionally, the predictive accuracy of the OTS for final visual acuity was evaluated.

One hundred eyes (86% males; mean age of trauma 53.6±18.4 years) of 100 patients were included. The initial mean VA was 1.7±0.8 (<20/800) logMAR (Snellen), while the final mean BCVA improved to 0.2±0.4 (20/32) (p<0.001). The mean OTS was 78.9±11.7, corresponding to rank 3. A significant correlation was found between final VA and initial VA (r=0.339, p=0.002), reoperation (r=0.311, p=0.003), iris defects (r=0.216, p=0.044), IOFB (r=-0.316, p=0.003) and lower OTS (r=-0.260, p=0.029). Multivariate analysis showed that initial VA and iris defects were significantly associated with final BCVA (p=0.008). The OTS in rank 3 predicted significantly lower VA than achieved. Ultimately, 78.4% of patients obtained a final VA of 0.2 (20/32) or better.

The prognosis for visual recovery after ocular trauma varies depending on the type and severity of the injury. Our findings confirm that an initial poor VA remains a significant prognostic indicator, consistent with previous studies. Notably, the OTS was not a reliable predictor of final VA in rank 3 cases. This can be attributed to the evolution of surgical techniques and technology, which may have reduced the OTS’s predictive accuracy. Also, the OTS fails to account for complications such as traumatic cataract, which is treatable and can significantly impact visual outcomes. There is a clear need for alternative prognostic models that can overcome these limitations and more accurately predict visual recovery following lenticular trauma.