Dr. Mehul Ashvin Kumar Shah, S05624, Dr. Siddharth Rajendragiri Gosai, Dr. Juhee Vishnu Agrawal, Dr. Shreya Shah
Abstract
Objective: To compare final visual outcomes of surgically treated traumatic cataract between open-globe and closed-globe injuries in children, as classified by the Birmingham Eye Trauma Terminology system.
Methods: We enrolled children meeting specific inclusion criteria, examined their eyes to review any co-morbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were re-examined postoperatively. We classified the cases of traumatic cataract as either open-globe (Group 1) or closed-globe (Group 2) according to the Birmingham Eye Trauma Terminology (BETT) system and compared visual acuity.
Result: Our study cohort of 1076 eyes with traumatic cataracts included 405 eyes in Group 1 and 671 in Group 2. Postoperatively, the visual acuity was > 20/60 in 223 (55.3%) and 377 (56.3%) operated eyes in Groups 1 and 2, respectively (p < 0.001, ANOVA). With further follow‑up, > 20/60 vision was significantly higher in Group 2 as compared to Group 1 (OR = 1.61; 95% CI, 0.85–3.02). Overall, 600 eyes (55.7%) regained final visual acuity > 20/60.
Conclusions: Closed-globe injury has more favourable prognosis for the satisfactory (> 20/60) visual recovery after effective management of traumatic cataracts in children.
Key words: Ocular Trauma; BETTS; Open globe injuries; closed globe injuries; Visual outcome
Introduction
Ocular trauma is an important cause of blindness in both developed and developing countries. (1, 2) Ocular injury may cause cataract (3, 4), which is particularly crucial among children because of vision development. (5, 6, 7)
The aetiology of ocular injury in rural areas is likely to differ from that in urban areas and is worthy of investigation [2-4]. The main strategy to prevent ocular injury is to gain knowledge of the cause of injury, which may enable more appropriate targeting of the resources toward preventing such injuries. Eye trauma represents a large, potentially preventable burden on both victims and society as a whole. [3]
Ocular trauma can cause cataracts. [1, 5, 6, 7] The methods used to evaluate the visual outcome in eyes with traumatic cataracts and senile cataracts are similar, [5] but the damages to other ocular tissues due to trauma may compromise the visual gain in eyes operated for traumatic cataracts. Hence, the success rates in gaining visual acuity may differ between these two types of cataract. Visual outcome of traumatic cataracts in children is associated with amblyopia (5, 6, and 7)
With the introduction of the Birmingham Eye Trauma Terminology system (BETT), the documentation of ocular trauma has been standardised. [8] Consequently, using BETT scoring, it is possible to study the visual outcomes following traumatic cataract surgery as well as the determinants predicting the outcome. Although the visual outcomes of traumatic cataracts in children have been reported previously, such investigations are either direct case studies or suffer from small sample size.
In the current study, we examined the visual outcomes following cataract surgery in children sustaining eye injuries, and compared the visual outcome between open-globe and close-globe injuries… Our study was conducted in a city located at the intersection of three Indian states: Gujarat, Madhya Pradesh, and Rajasthan. Qualified ophthalmologists at our institute provided low-cost eye services, mainly to the underprivileged people belonging to the tribal population of 4.2 million in this area.
Patients and Methods
We obtained approval from the hospital administrators and its research committee to conduct this study and the written consent was obtained from all participants.
This was an observational cohort study designed in 2005. All children with traumatic cataract in either eye who were diagnosed and treated between January 2006 and December 2016 were included in the initial pool. Among initial pool, the patients who agreed to participate and without other serious injuries were enrolled. Data were retrieved from the medical records and collected in a pre-tested online form.
For each patient enrolled in our study, we obtained medical history, including the details of injury, eye treatments, and surgery performed to manage the ocular trauma. The initial data and follow-up reports were collected using the online BETT format of the International Society of Ocular Trauma. The details of the surgeries were also collected using a pre-tested online form.
The cases of traumatic cataract in children were classified as open- or closed-globe injuries. The open-globe injuries were further categorised into those with laceration or rupture. Moreover, lacerations of the eyeball were subcategorised into perforating injuries, penetrating injuries, or injuries involving an intraocular foreign body. The closed-globe group was subdivided into lamellar laceration and contusion.
The demographic details were also collected, which include origin of referral to our clinic, place of residence, activity at the time of injury, object causing injury, and previous examinations and treatments. After enrolment, all patients were examined using a standardized method. Visual acuity was checked using the guidelines of American Association of Paediatric Ophthalmology and the anterior segment was examined using a slit lamp.
The cataracts were classified based on the lenticular opacity. The cataract was defined as total when the clear lens matter between the capsule and nucleus was not observed by the examiner. Similarly, when the capsule and organised matter were fused to form a membrane with varying density, it was defined as a membranous cataract. When loose cortical material was found in the anterior chamber together with a ruptured lens capsule, the cataract was defined as a white soft cataract with ruptured capsule. A lens with a rosette pattern of opacity was classified as a rosette-type cataract, majority of them were considered as partial cataracts. Using this classification, we were able to cover all cataract cases in this study. We observed that the cataract morphology was primarily influenced by the type, force or object of injury, and the time interval between injury and examination. (9)
For a partially opaque lens, the posterior segment examination was carried out with an indirect ophthalmoscope and a +20 D lens. When the optical medium was not clear, a B-scan was performed to evaluate the posterior segment. However, co-morbidities were identified during the examination in both groups. (9)
The surgical technique chosen was selected according to the morphology and condition of the tissues other than the lens. With the lenses that had either a white soft or rosette type of cataract, uni-manual or bimanual aspiration was used. Membranectomy and anterior vitrectomy, were performed either via an anterior or pars plana route when the cataract was membranous.
In all children underwent corneal wound repair, the traumatic cataract was managed with a second procedure. Recurrent inflammation was more prominent in patients who had undergone previous surgery for trauma. In such cases where ocular media was found to be hazy due to the inflammation of anterior vitreous, difficulties of examination was done under anaesthesia. (10)In children younger than two years, both lensectomy and vitrectomy were performed via a pars plana route, leaving the rim of anterior capsule for the secondary implant, and the same surgical procedures were used to manage the traumatic cataract. The lens implantation as a part of the primary procedure was avoided in all children younger than two years. All children above 2 years were treated with primary posterior capsulotomy and vitrectomy in case of severe inflammation.
We performed capsulectomy and vitrectomy via an anterior/pars plana route. If the sulcus fixated lens found subluxated, we corrected it surgically and recurrently developed membrane was removed with surgical procedure.
All patients with injuries and without infection were treated with topical and systemic corticosteroids and cycloplegics. The duration of medical treatment depended on the degree of inflammation in the anterior and posterior segments of the operated eye. The operated patients were re-examined consecutively after 24 h, 3 days, 1 week, 2 weeks, and 6 weeks to enable the refractive correction. The follow-up was scheduled for these dates; then monthly for three months; and then in every three months for one year.
At every follow-up examination, visual acuity was tested using AAPOS(American Association for Pediatric Ophthalmology and Strabismus) guidelines. The anterior segment was examined with a table or hand held slit lamp, and the posterior segment was checked with an indirect ophthalmoscope. In case of younger children, examination was done under anaesthesia. (10)
During the examination, data were entered online using the pre-tested forms designed by the International Society of Ocular Trauma (initial and follow-up forms), which were exported to a Microsoft Excel spreadsheet later on. The data were audited periodically to ensure completion. We used the Statistical Package for the Social Sciences (SPSS 22) to analyse the data. Descriptive statistics and cross tabulation were performed to evaluate the role of each variable. The dependent variable was vision > 20/60 at follow-up in 6 weeks after cataract surgery. The independent variables were age, gender, place of residence, time interval between injury and cataract surgery, primary posterior capsulectomy and vitrectomy procedure, and type of ocular injury.
Results:
The study cohort consisted of 1076 patients with traumatic cataracts, including 405(37.6) eyes with open-globe ocular injuries and 671(62.4%) eyes with closed-globe injuries (Figure 1, Table-1). Of the patients, 492 (70.8%) were male and 314(29.2%) were female. The mean patient age was 10.1±4.4 years (range, 0–18 years).
We analysed several demographic factors, including origin of patient referral, socioeconomic status (79% were from a lower socioeconomic class), and residence (95% were from a rural area); however, none of these factors showed a significant relationship with final visual acuity. The object causing the injury and the activity at the time of the injury was also not significantly associated with satisfactory final visual acuity (Table 1). However, wooden sticks were the most common agent causing injury (25.6%). The comparison between pre- and post-operative visual acuity showed that treatment significantly improved the visual acuity (Table 1; Pearson’s χ2 test, p < 0.001; ANOVA, p = 0.001). An intraocular lens was implanted in 919 (85.4%) cases. Aspiration was performed using one or two ports in 777 cases (72.2% of the patients in the open-globe group, and was significantly associated with improved visual acuity (p < 0.001).
When we compared the visual outcome in children above and under five years, we found significant difference (p=0.000). In our cohort, only 39 cases (3.6%) reported within 24 hours of injury.
The comparison between open-globe and closed-globe groups (Table 1) showed significant differences in variables other than final visual outcome, which include age, gender, origin of patient referral, object of injury, early reporting, cataract morphology, zones of injury surgical technique, number of surgeries, and lens implantation.
The primary surgery was cataracts in 699 cases (65%). In 821 cases, only one surgery was applied (76.3%); whereas in 32 cases, 3 surgeries were needed (3.2%). Overall, we observed significant improvement in visual acuity if the number of surgery is minimum (p=0.001).
The lens implantation was done in 919 cases (85.4%). Significant improvement in visual acuity was observed in pseudophakia (p=0.000).
Primary lens Implantation was done in 887 cases (96.4%), and secondary lens implantation was done in 32 cases (3.6%).
We performed primary capsulotomy and vitrectomy in 329 cases (30.6%), which caused significant improvement in the visual outcome (p=0.001). During examination, we found that in 969 cases (90%), injuries took place in zone 1, and the location of injury has significant effect on visual outcome (p=0.000).
Postoperative vision was compared according to the type of injury. Primary posterior capsulectomy and anterior vitrectomy, commonly performed for eyes with significant inflammation, resulted in significant improvement in final visual acuity (Table 1; p < 0.001). We performed intraocular lens (IOL) relocation in 5 cases and secondary membranectomy in 7 cases.
At 6 weeks following the operation, the visual acuity was > 20/60 in 223 (55.3%) cases in the open-globe group, and 377 cases (56.3%) in the closed-globe group (p < 0.001, ANOVA, χ2); this difference was significant (OR = 1.61, 95% CI 0.85–3.02). Overall, 600 eyes (55.7%) regained a final visual acuity > 20/60 (Table 1).
Table-2 shows complications may affect visual outcome.
Discussion:
Visual gain in case of traumatic cataract among children does not entirely depend on the condition of lens (5, 6, 7, 11, and 12).
In our study, the comparison between open-globe and closed-globe injuries leading to traumatic cataract in children showed that satisfactory improvement in vision following the surgical management was significantly higher in those with closed-globe injuries (Table 1).
To the best of our knowledge, this is the first study demonstrating the comparison of final visual outcomes between these two groups in children using the BETT classification system.
Previously, Shah et al have reported visual outcome in a comparative study involving open and closed globe injuries in adults, where visual outcome was found better in open globe group. (13, 14, 15)
Our cohort of patients with traumatic cataracts was much younger than those in other studies. [16,17] Thus, appropriate intervention to avoid visual disability in our cohort would be more cost effective because the disability-adjusted life years saved by the successful intervention would be much higher.
Although we had a large proportion of males in our cohort, the difference between the number of males and females was not statistically significant. Many working women in the tribal areas may be at increased risk for ocular injuries and traumatic cataracts; this may explain the gender distribution noted in our study. (16, 17) Wos et al. have noted that a large proportion of the population with traumatic cataracts in their series is male. [17]
However, Baclouti et al. did not find any gender difference in traumatic cataracts in their study in Tunisia. [18] We found a significant (p = 0.020) gender variation in open-globe injuries where males were predominantly affected.
In our study, about 50% children joined the treatment regimen through the outreach program, which resulted in delayed reporting. Such delay in reporting may cause alteration in the morphology and so the surgical procedure. This is the reflection of health seeking behaviour of the community served. (11)
Using a large database, we attempted to systematically classify the morphology of traumatic cataract and to select surgical techniques accordingly. We used a practical grading of cataracts to enable ophthalmologists to determine the best mode of managing them. This grading differs from the standard grading used for senile cataracts. [9] Various studies have been done on this topic. Krishnamachary et al. have found 52.3% of all cataracts as total, whereas our results revealed 26.6% total cataracts. [19] Vajpayee has reported type-1 and -2 openings in the posterior capsule with penetrating injury. [20] whereas we found a membranous type of cataract in 12.1% of cases. This is suggestive of late reporting, as the membranous transformation of lens by the fusion of anterior and posterior capsules may occur over time.
Shah et al have also reported that surgical technique was decided according to the morphology. (9)
Primary lens implantation was done in 65% as compared to 85.4% in our cohort. (21, 22)
Secondary lens implantation was done in 4 % as compared to 39 (3.6%) in the current study. (21, 22)
Primary posterior capsulotomy was performed in 30% cases, which showed significant improvement in visual outcome. Shah et al have also reported similar finding in general population. (20)
We are not aware of any study which has compared open and closed globe injury causing traumatic cataract in children. Shah et al have reported similar finding in general population. (23)
Conclusions:
We observed good visual outcomes after managing traumatic cataracts in children. Taken together, our results demonstrate that satisfactory visual acuity following cataract surgery is more likely in closed globe injuries as compared to open globe injuries in case of children.
References:
- Khatry SK, Lewis AE, Schein OD, Thapa MD, Pradhan EK, Katz J The epidemiology of ocular trauma in rural Nepal. Br J Ophthalmol. 2004; 88:456-60.
- Abraham DI, Vitale SI, West SI, Isseme Epidemiology of eye injuries in rural Tanzania. Ophthalmic Epidemiol.1999;6:85-94
- Alfaro DV, Jablon EP, Rodriguez Fontal M, Villalba SJ,Morris RE, Grossman M, Roig-Melo E Fishing-related ocular trauma. American Journal of Ophthalmology.2005;139: 488-492
- Shah M, Shah S, Khandekar R. Ocular injuries and visual status before and after Their management in the tribal areas of Western India-A historical cohort study Grafes Arch Clin Exp Ophthalmol.2008; 246:191–197.
- Mehul Shah, Shreya Shah, Lalchand Gupta, Amisha Jain and Ruchir Mehta Predictors of visual outcome in traumatic cataract 2014; 4: 152-159Shah M1, Shah S, Upadhyay P, Agrawal R. Controversies in traumatic cataract classification and management: a review Can J Ophthalmol. 2013 48:251-8. doi: 10.1016/j.jcjo.2013.03.010
- Agrawal R1, Shah M, Mireskandari K, Yong GKSee comment in PubMed Commons belowControversies in ocular trauma classification and management: review.Int Ophthalmol.2013; 33:435-45. Doi: 10.1007/s10792-012-9698-y. Epub 2013 Jan 22
- Kuhn F, Morris R, Witherspoon CD, Mester V the Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol.2004; 27:206-10.
- Shah, M. A., S. M. Shah, Shashank Shah et al. Morphology of traumatic cataract: does it play a role in final visual outcome? BMJ Open 2011; 1: e000060.
- Mehul, A. Shah., et al. Innovative methods of Anesthesia for eye surgery in children. J Anesth Surg2015: 2: 1-3.
- Shah, M. A., S. M. Shah S B. Visual outcome of traumatic cataract in pediatric age group. Eur J Ophthalmol:2012: 0
- Mehul A. Shah, Shreya M. Shah, Shashank B. Shah et al. Effect of interval between time of injury and timing of intervention on final visual outcome in cases of traumatic cataract Eur J Ophthalmol 2011;21:760-5.
- Shah, M. A., S. M. Shah, Shah S.B. Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol2011; 249: 1775-81.
- Shah, M., S. Shah, Shah S.B. Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Indian J Ophthalmol 2011; 59: 217-22.
- Smith AR, O’Hagan SB, Gole GAEpidemiology of open- and closed-globe trauma presenting to Cairns Base Hospital, Queensland.Clin Experiment Ophthalmol.2006; 34:252-9.
- Shah M, Shah S, Khandekar R. Ocular injuries and visual status before and after Their management in the tribal areas of Western India-A historical cohort study Grafes Arch Clin Exp Ophthalmol 2008; 246:191–197.
- Wos M, Mirkiewicz-Sieradzka B. Traumatic cataract–treatment results. Klin Oczna.2004; 106:31-4.
- Baklouti K, Mhiri N, Mghaieth F, El Matri L. Traumatic cataract: clinical and therapeutic aspects. Bull Soc Belge Ophtalmol. 2005; 298:13-7.
- Krishnamachary M, Rathi V, Gupta S Management of traumatic cataract in children. J Cataract Refract Surg. 1997; 23:681-7.
- Vajpayee RB, Sharma N, Dada T, Gupta V, Kumar A, Dada VK. Management of posterior capsule tears. Surv Ophthalmol.2001; 45:473-88.
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Table-1: Comparative results amongst open and closed globe injuries in children.
| Parameter | Open globe | Closed globe | Total | ||||||||||||||||||
| No | % | No | % | No | % | P value | |||||||||||||||
| Entry | |||||||||||||||||||||
| Outreach | 195 | 48.0 | 320 | 47.7 | 515 | 47.9 | 0.3 | ||||||||||||||
| Self | 210 | 52.0 | 351 | 52.3 | 561 | 52.1 | |||||||||||||||
| Total | 405 | 72.2 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Age distribution | |||||||||||||||||||||
| <5 | 62 | 15.3 | 115 | 17.1 | 177 | 16.4 | 0.243 | ||||||||||||||
| >5 | 343 | 84.7 | 556 | 82.9 | 899 | 83.6 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Age distribution | |||||||||||||||||||||
| 0 to 1 | 4 | 0.9 | 12 | 1.8 | 16 | 1.5 | 0.486 | ||||||||||||||
| 2 to 5 | 58 | 14.3 | 103 | 15.4 | 161 | 15.0 | |||||||||||||||
| 6 to 10 | 168 | 14.5 | 223 | 33.2 | 391 | 36.3 | |||||||||||||||
| 11 to 18 | 175 | 43.2 | 333 | 49.6 | 508 | 47.2 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Gender | |||||||||||||||||||||
| Female | 119 | 29.4 | 195 | 29.1 | 314 | 29.2 | 0.482 | ||||||||||||||
| Male | 286 | 70.6 | 476 | 70.9 | 762 | 70.8 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Object of Injury | |||||||||||||||||||||
| Ball | 6 | 1.5 | 7 | 1 | 13 | 1.2 | 0.000 | ||||||||||||||
| Cattle Horn | 14 | 3.5 | 29 | 4.3 | 43 | 4 | |||||||||||||||
| Cattle Tail | 8 | 2.0 | 49 | 7.3 | 57 | 5.3 | |||||||||||||||
| Fire work | 20 | 4.9 | 18 | 2.7 | 38 | 3.5 | |||||||||||||||
| Fall | 12 | 2.9 | 70 | 10.4 | 81 | 7.5 | |||||||||||||||
| Other | 2 | 0.5 | 29 | 4.3 | 31 | 2.9 | |||||||||||||||
| Sharp object | 74 | 18.3 | 14 | 2.1 | 88 | 8.2 | |||||||||||||||
| Blunt object | 27 | 6.7 | 185 | 27.6 | 212 | 19.7 | |||||||||||||||
| Stone | 91 | 22.5 | 137 | 20.4 | 228 | 21.2 | |||||||||||||||
| Wooden stick | 151 | 37.3 | 125 | 18.6 | 276 | 25.6 | |||||||||||||||
| Unknown | 0 | 0 | 8 | 1.2 | 8 | 0.7 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Object of injury compared to wooden stick | |||||||||||||||||||||
| Wooden stick object | 151 | 37.3 | 125 | 18.6 | 276 | 25.6 | 0.000 | ||||||||||||||
| Other object | 254 | 62.7 | 546 | 81.4 | 800 | 74.4 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Reporting | |||||||||||||||||||||
| 0 to 1 | 29 | 7.2 | 10 | 1.5 | 39 | 3.6 | 0.000 | ||||||||||||||
| 2 to 4 | 50 | 12.3 | 53 | 7.9 | 103 | 9.6 | |||||||||||||||
| 5 to 30 | 91 | 22.5 | 115 | 17.1 | 206 | 19.1 | |||||||||||||||
| More | 235 | 58.0 | 493 | 73.5 | 728 | 67.7 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Zones | |||||||||||||||||||||
| 1 | 333 | 82.2 | 636 | 94.8 | 969 | 90.1 | 0.000 | ||||||||||||||
| 2 | 71 | 17.5 | 32 | 4.8 | 103 | 9.6 | |||||||||||||||
| 3 | 1 | 0.2 | 3 | 0.4 | 4 | 0.4 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Morphology | |||||||||||||||||||||
| Membranous | 19 | 4.7 | 114 | 17 | 133 | 12.4 | 0.000 | ||||||||||||||
| Rosette | 6 | 1.5 | 36 | 5.4 | 42 | 3.9 | |||||||||||||||
| Soft fluffy | 322 | 79.5 | 169 | 25.2 | 491 | 45.6 | |||||||||||||||
| TotalCataract | 57 | 14.1 | 342 | 51.0 | 399 | 37.1 | |||||||||||||||
| Subluxated | 1 | 0.2 | 10 | 1.5 | 11 | 1.0 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Surgical Technique | |||||||||||||||||||||
| Unimanual Aspiration | 179 | 44.2 | 205 | 30.5 | 384 | 35.7 | 0.000 | ||||||||||||||
| Lensectomy & Vitrectomy | 104 | 25,7 | 195 | 29.1 | 299 | 27.8 | |||||||||||||||
| Bimanual Aspiration | 122 | 30.1 | 271 | 40.4 | 393 | 36.5 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Primary Posterior Capsulectomy Vitrectomy | |||||||||||||||||||||
| Not performed | 282 | 69.6 | 465 | 69.3 | 747 | 69.4 | 0.483 | ||||||||||||||
| Performed | 123 | 30.4 | 206 | 30.7 | 329 | 30.6 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Number of surgeries | |||||||||||||||||||||
| 1.00 | 272 | 67.2 | 549 | 81.8 | 821 | 76.3 | 0.000 | ||||||||||||||
| 2.00 | 110 | 27.2 | 109 | 16.2 | 219 | 20.4 | |||||||||||||||
| 3.00 | 22 | 5.4 | 12 | 1.8 | 34 | 3.1 | |||||||||||||||
| 4.00 | 1 | 0.2 | 1 | 0.1 | 2 | 0.2 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Lens Implant | |||||||||||||||||||||
| No Implant | 67 | 16.5 | 90 | 13.4 | 157 | 14.6 | 0.094 | ||||||||||||||
| Implant | 338 | 83.5 | 581 | 86.6 | 919 | 85.4 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
| Final Visual Outcome | |||||||||||||||||||||
| <1/60 | 94 | 23.2 | 155 | 23.1 | 249 | 23.1 | 0.000 | ||||||||||||||
| 1/60 to 3/60 | 41 | 10.1 | 69 | 10.3 | 110 | 10.2 | |||||||||||||||
| 20/200 to 20/80 | 46 | 11.4 | 70 | 10.4 | 116 | 10.8 | |||||||||||||||
| 20/60 to 20/40 | 86 | 21.2 | 97 | 14.5 | 183 | 17.0 | |||||||||||||||
| 20/40 to 20/20 | 137 | 33.8 | 280 | 41.7 | 417 | 38.6 | |||||||||||||||
| Uncooperative | 1 | 0.2 | 0 | 0 | 1 | 0.1 | |||||||||||||||
| Total | 405 | 100 | 671 | 100 | 1076 | 100 | |||||||||||||||
Table-2 Complications affected visual outcome
| Number
(n) |
Percent
(%) |
||
| CORNEAL OPACITY | 32 | 3.0 | |
| DECENTRED IOL | 13 | 1.3 | |
| ENDOPHTHELMITIS | 5 | .5 | |
| HYPHEMA | 8 | .7 | |
| INFLAMMATION | 18 | 1.7 | |
| IRIDODIALYSIS | 2 | .2 | |
| SECONDARY GLAUCOMA | 6 | .6 | |
| OPTIC CAPTURE | 6 | .6 | |
| PAINFUL BLIND EYE | 1 | .1 | |
| PHITHISIS | 5 | .5 | |
| RD | 8 | .8 | |
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