Clinical Outcomes Review in the Management of Traumatic Cataract With IOL Implantation Following Open Globe Injury

Abstract

Purpose: (1) To describe the visual outcomes and incidence of glaucoma for patients receiving an intraocular lens (IOL) for traumatic cataract following open globe injury. (2) To identify prognostic factors. Methods: This is a retrospective case series study using the MEEI Trauma Database. We identified 89 patients treated with IOL for traumatic cataract after open globe injury. Electronic medical records were reviewed for last recorded best-corrected visual acuity (BCVA) prior to IOL implantation, and BCVA at 2-month, 6-month, 1-year, and final follow-up. Outcomes were compared for mechanism of injury, zone of injury, lensectomy technique, timing of surgery (primary vs. secondary IOL), and IOL type. Results: The follow-up from IOL implantation ranged from 51 to 3101 days. The mean pre-IOL implantation BCVA was 1.14±1.05 (SD) logMAR with 3 light perception (LP) eyes and 0 no light perception (NLP) eyes. At final follow-up the mean BCVA was 0.40±0.65 (SD) logMAR with 1 LP eye and 1 NLP eye (P < 0.001, 2-tailed paired Student t test). Final BCVA worse than 20/40 was associated with pre-IOL implantation BCVA worse than 20/60 (93%) (p<0.001), traumatic lensectomy (21%) (p<0.004), and sutured IOLs (32%) (p<0.001). 17 eyes developed glaucoma after IOL implantation, requiring glaucoma medications (15 eyes) or glaucoma surgery (5 eyes). Conclusion: Patients who received IOL implantation for traumatic cataract following open globe injury showed improvement in their BCVA. Predictors of poor visual outcomes included worse pre-implantation BCVA, traumatic lensectomy, and use of a sutured IOL. Glaucoma was a not uncommon complication, but did not show association with worse visual outcomes.