Refractive and visual outcomes after surgery for pediatric traumatic cataract

Purpose: To describe refractive and visual outcomes of pediatric traumatic cataract requiring surgery and evaluate the factors influencing success. Setting: Hospital for Sick Children, Toronto, Ontario, Canada. Design: Retrospective case series. Methods: Charts of children having lensectomy for traumatic cataract between January 1, 2000, and June 30, 2015, were reviewed for demographic information, visual and refractive outcomes, complications, and surgical details. Results: One hundred six children (mean age 7.6 years +/- 3.9 [SD]) were included. The median follow-up was 41 months (range 3 to 155 months). Seventy-nine children had open-globe injuries and 27 had closed-globe injuries. Patients with open-globe injuries were younger than those with closed-globe injuries (mean age 6.9 versus 10.4 years; P<.05). The final corrected distance visual acuity (CDVA) was 20/40 or better in 47 children. In the 94 children who had intraocular lens placement, 54% with open-globe injuries and 55% with closed-globe injuries achieved a mean absolute prediction error of 1.0 diopter or less in the early postoperative period. Open-globe injuries and amblyopia were associated with worse visual outcomes (odds ratio [OR], 2.8 and P=.03 versus OR, 2.4 and P=.04) and refractive outcomes (OR, 3.1 and P=.02 versus OR, 3.8 and P=.04). Age younger than 5 years was associated with worse refractive outcomes (OR, 2.88; P=.02). Conclusions: Children requiring surgery for traumatic cataract can have good visual and refractive outcomes. Those with open-globe and those with closed-globe injuries both had good early postoperative refractive accuracy. Sixty-three percent of children with closed-globe injuries attained a CDVA of 20/40 or better at the final follow-up.