Ocular trauma is the leading cause of unilateral blindness all over the world. Traumatic cataract is a common sequela of ocular injuries in adults and children. The incidence of ocular injuries varies in different parts of the world. From India, the reported incidence is 20.53%. Management of traumatic cataract that results from either blunt or penetrating ocular trauma needs special consideration because of associated injury to ocular and periorbital structures^{. [1]}. 

Surgery of traumatic cataract can be primary or secondary. Primary cataract removal is suggested if the lens is fragmentized, swollen causing a pupillary block or to examine the posterior segment otherwise blocked by lens opacity. Secondary cataract removal is more beneficial because of improved visibility, proper intraocular lens calculation, and less chances of postoperative inflammation. ^[2] Ocular trauma can occur via many mechanisms, affecting the crystalline lens in various ways, including perforating or blunt trauma, electric shock, ultraviolet and ionizing radiation, and chemical injuries. ^[3]

In penetrating trauma, where an object with a sharp edge, such as glass, wood, or metal, pierces the eye, a traumatic cataract may develop immediately if the object reaches the lens after passing through the cornea. The lens may also be damaged or completely ruptured, leading to partial or complete cataracts and blindness (Traumatic Cataract Secondary to Penetrating Ocular Injury). ^[4]

 Chemical trauma may occur when a foreign substance enters the eye and alters the composition of the lens fibers, leading to traumatic cataracts. Radiation exposure can also damage and rupture the lens, resulting in traumatic cataracts over time. Radiation-induced ocular trauma is often seen in children. ^[5] Opacification of the lens may occur immediately after an injury or years later; the type of cataract formed will depend on the nature and extent of the ocular trauma. Penetrating trauma may result in a cataract proportional to the size of the opening in the lens capsule. No morphologic grouping exists for cataracts due to penetrating trauma^{. [6]}

In contrast, cataracts secondary to blunt trauma often exhibit a distinctive rosette- or flowershaped appearance. Larger capsular openings can cause the entire lens to become cataractous, while smaller openings may produce only a focal opacity. ^[7] Additionally, blunt trauma can cause cataract formation without a loss of capsular integrity due to the forces of the original trauma or subsequent inflammation. Ocular trauma may also lead to subcapsular cataracts. Electric shock can cause diffuse milky-white opacification or multiple snowflake-like opacities. ^[8]

Ultraviolet radiation can induce true exfoliation of the anterior lens capsule with subsequent cataract development. The ionizing radiation used to treat ocular tumors or during cardiac interventions may cause posterior subcapsular opacities. Finally, chemical injuries to the lens can result from various sources, including naphthalene, thallium, lactose, and galactose^{. [9]}

The aim of this study was to evaluate the final visual outcome of a series of patients with secondary extraction of traumatic cataract along with demographic features and modes of trauma.

This is a prospective study was conducted in the Department of Ophthalmology, Mahavir Institute of Medical Sciences and Research Centre in patients who was presented with unilateral traumatic cataract, underwent surgical intervention and completed at least 6 months.

Patients of both genders and all age groups with unilateral traumatic cataract were included in the study. Patient's data including demographic details, causative agents, initial visual acuity, intraocular pressure, slit lamp examination findings, B-scan findings, treatment / surgery, early and late complications and final outcome were obtained from patient's chart in the hospital record. Removal of cataract was performed as a second and separate procedure in patients of perforating ocular injury, intraocular lens (IOL) implantation was performed only in patients with adequate capsular support. Patients without any capsular support were kept aphakic. Anterior vitrectomy was performed in patients with posterior capsular tear and vitreous prolapse.

Patients were subsequently followed-up on 1 day, 1 week, 6 weeks, 3 months and 6 months postoperatively. At each follow-up visit patient's visual acuity was recorded. Final best corrected visual acuity (BCVA) was recorded on the 5th postoperative visit that is at 6 months.

According to BETTS classification patients were categorized as open globe injury and closed globe injury. Tonometry was done by Applanation tonometer in cases of blunt injury. After examination and diagnosis, patients were subjected for routine blood and urine investigations. In cases of polytrauma cardiovascular system, respiratory system, central nervous system and per abdomen were examined. Physician and anaesthetist reference were done for fitness to undergo surgery and surgery was done in presence of anaesthetist.

Statistical Analysis

 The data processing was carried out on Statistical Package for Social Science (SPSS) version 25.0 software and expressed as frequencies, percentages, mean and standard deviation.

In the current study, the majority of cases were seen in the 5–15-year age group, with a male preponderance. The majority of cases (40%) were in the 0–15 years age group, followed by 31% in the 15–24 years age group.

Table 1: Age Distribution

Table2:SexDistribution

 Table3: Type of Injury

In table 3, 54% of cases involved penetrating trauma, while 46% were blunt trauma. A wooden stick was the most common object causing trauma.

Table 4: Objects Causing Trauma

Associated ocular injuries significantly impact the ultimate visual prognosis in cases of traumatic cataract. Corneal and iris injuries were the most commonly observed associated injuries. The most common object causing trauma was a wooden stick (49%), followed by metallic objects (18%), plastic (8%), and brick/stone (8%).

Table 5: Associated Ocular Damage

Depending on the condition of the eye, surgeries included Small Incision Cataract Surgery (SICS) with Posterior Chamber Intraocular Lens (PCIOL), SICS with Anterior Chamber Intraocular Lens (ACIOL), and lens extraction with anterior vitrectomy. Corneal (corneoscleral) tear: 54% of cases, Injury to the iris: 28% of cases. Zonular disruption and corneal opacity were noted in 6% each. Old retinal detachment (RD) was identified in 3% of cases.

Table 6: Type of Surgery

In table 6, the type of surgical intervention depended on the extent of the trauma and the condition of the eye: 91% of cases underwent Small Incision Cataract Surgery (SICS) with PCIOL implantation. 3% required SICS with ACIOL. 6% of cases involved lens extraction with anterior vitrectomy

Age wise analysis showed that majority of cases occurred in younger age group (21-40). This is because of the greater involvement in outdoor activity and recreational activity and work pattern of people. Most injuries resulted from stick followed by metal. Other studies also showed an increased incidence of traumatic cataract in younger age group. Daljit Singh showed similar age group distribution. ^{[10, 11]} This study showed a male preponderance (72.5 %). This is because men are more exposed to ocular trauma because of occupation and they are from age earning group. The study found that most of the cases i.e. 23 (57.5 %) were caused by stick and metal.

This is because of the rural people who are working in fields. ^[11]The type of injury was mostly of penetrating type. Nine cases (22.5%) with metallic particles and 7 cases (17.5 %) with thorn and 6 cases (15 %) with stone. These were seen in people working in farming and road construction works. One cases injury was caused by cricket ball, one case injury was caused by glass piece and one case was caused by forceful trauma by water jet at vehicle washing centre seen in young individuals engaged in recreational activity.

Krishnamachary M also found that most of the injuries i.e., 54.7% were caused by stick or bow and arrow. ^[12] The preoperative visual acuity in this series of study is as follows, 15 (37.5 %) of the eyes had PL and PR only. 17 (42.5 %) of eyes had perception of hand movements and 8 cases (20 %) had 3/60 to counting fingers ½ meters. In the studies conducted by Renuka and Srinivasan et al. and Krishnamachary M, the preoperative visual acuity was less than 6/60 to PL and PR in most of their cases. ^[13-16] Out of 40 cases which were followed up after 6 weeks, in 11 cases (29 %) final visual outcome was 6/18 and above and in 24 cases (63 %) final visual outcome was between 6/18-3/60. The main cause for the impaired vision in this study was due to corneal scars and opacity obstructing the visual axis and causing irregular astigmatism. In 3 cases (8%) visual acuity was less than 3/60.

 In one case patient had developed a traumatic vitreous hemorrhage which resolved minimally and patient had poor vision. In the other 2 cases there was significant vitreous loss and weak zonular support were kept aphakic resulted in poor visual outcome. Marcus Blum reported good visual outcome of 90%. ^{[17, 20]} Daljit Singh reported 70%. Renuka Srinivasan noted 88.2% of visual outcome. ^[18,19] This study of 40 cases of traumatic cataract almost all of which were managed by cataract extraction with IOL implantation showed moderate visual outcome of 50% in comparison with other studies

Traumatic cataract, resulting from ocular injury, presents a unique clinical challenge due to its variable etiology, severity, and association with other ocular trauma^.[26] A prospective study design is particularly valuable in assessing the clinical evaluation and management strategies for this condition, as it allows for systematic data collection and longitudinal follow-up of outcomes.

The clinical evaluation of traumatic cataracts begins with a comprehensive history, including the mechanism of injury, duration since trauma, and associated ocular and systemic symptoms. Slit-lamp examination and B-scan ultrasonography are critical tools for assessing the integrity of the anterior segment, the lens opacification pattern, and any posterior segment involvement, especially in cases where media opacity precludes direct visualization^.[21]

Management of traumatic cataracts depends on several factors, including the patient's age, the extent of lens damage, and associated ocular injuries such as corneal lacerations, uveitis, or retinal detachment. Surgical intervention is often the cornerstone of treatment. Phacoemulsification with intraocular lens (IOL) implantation is preferred in most cases^;[22] however, the decision for primary or secondary IOL placement is influenced by the extent of ocular trauma and inflammatory response.

In pediatric cases, traumatic cataracts pose additional challenges due to amblyopia risk and the need for precise IOL power calculation. ^[23]Timing of surgery and postoperative care, including amblyopia therapy, are critical for optimizing visual outcomes.

Postoperative complications such as posterior capsular opacification^,[24] secondary glaucoma, or retinal detachment must be closely monitored. Anti-inflammatory therapy, careful wound management, and follow-up imaging play crucial roles in minimizing complications and improving prognosis.

Prospective studies on traumatic cataracts help in understanding trends, refining surgical techniques, and identifying factors influencing visual outcomes^.[25] They emphasize the importance of multidisciplinary care involving ophthalmologists, pediatricians, and trauma specialists to address the complex needs of these patients.

Primary posterior capsulectomy with anterior vitrectomy may improve the final visual outcome in cases of traumatic cataract. These findings should be confirmed in a study of a larger population that includes multiple centers.

In our study males were predominantly affected by traumatic cataract because of their nature of work and outdoor occupation. The age group of 5-15 years formed the core group of people to get traumatic cataract. The final visual outcome showed good result however the final visual outcome depends upon the extent of associated ocular injuries. Effective Intervention and management are the key points in preventing monocular blindness due to traumatic cataract

1. Katz J, Tielsch JM. Lifetime prevalence of ocular injuries from the Baltimore eye survey. Arch Ophthalmol 1993;111:1564 -8.
2. Ngrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143-69.
3. Vats S, Murthy GV, Chandra M, Gupta SK, Vashist P, Gogoi M. Epidemiological study of ocular trauma in an urban slum population in Delhi, India. Indian J Ophthalmol 2008;56:313-6
4. Kuhn F, Morris R, Witherspoon CD, et al. The birmingham eye trauma terminology system (BETT). J Fr Ophtalmol 2004;27(2):206-10.
5. Bekibele CO, Fasina O. Visual outcome of traumatic cataract surgery in Ibadan, Nigeria. Niger J Clin Pract 2008;11(4):372–5.
6. Koenig SB, Ruttum MS, Lewandowski MF, et al. Pseudophakia for traumatic cataracts in children. Ophthalmology 1993;100(8):1218–24
7. Mohammadpour M, Jafarinasab MR, Javadi MA. Outcomes of acute postoperative inflammation after cataract surgery. Eur J Ophthalmol 2007;17(1):20-8.
8. Hemo Y, BenEzra D. Traumatic cataracts in young children. Correction of aphakia by intraocular lens implantation. Ophthalmic Paediatr Genet 1987;8(3):203–7.
9. Awner S, Buckley EG, DeVaro JM, et al. Unilateral pseudophakia in children under 4 years. J Pediatr Ophthalmol Strabismus 1996;33(4):230-6.
10. Sofi IA, Bharti AR, Gupta SK, et al. Visual outcome and post-operative complications of traumatic cataract. J. Evolution Med. Dent. Sci. 2016;5(38):2307-10.
11. Zaman M, Iqbal S, Sanaullah, et al. Frequency and visual outcome of traumatic cataract. J Postgrad Med Inst 2006;20(4):330-4.
12. Bhandari AJ, Jorvekar SA, Singh P, et al. Outcome after cataract surgery in patients with traumatic cataract. Delta J Ophthalmol.2016;17:56-8.
13. Panda A, Kumar S, Das H, et al. Striving for the perfect surgery in traumatic cataract following penetrating trauma in tertiary care hospital in eastern Nepal. J Nepal Med Assoc 2007;46(167):119-25
14. Memon MN, Narsani AK, Nizamani NB. Visual outcome of unilateral traumatic cataract. J Coll Physicians Surg Pak 2012;22(8):497-500
15. Synder A, Kobielska D, Omulecki W. Intraocular lens implantation in traumatic cataract. Klin Oczna 1999;101(5):343-6
16. Staffieri SE, Ruddle JB, Mackey DA. Rock, Paper and scissors? Traumatic pediatric cataract in Victoria 1992- 2006. Clin Experiment Ophthalmol 2010;38(3):237-41
17. Shah MA, Shah SM, Shah SB, et al. Morphology of traumatic cataract: does it play role in final visual outcome. BMJ Open 2011;1(1):e000060. doi: 10.1136./ bmjopen2011-000060.
18. Ahmed N, Aziz T, Akram S. Visual outcome after primary IOL implantation for traumatic cataract. Pak J Ophthalmol. 2011;27(3):152-54.
19. Kumar S, Panda A, Badhu BP, et al. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract. J Nepal Med Assoc 2008;47(172):179-85.
20. Eckstein M, Vijayalakshmi P, Killedar M, et al. Use of intraocular lenses in children with traumatic cataract in south India. Br J Ophthalmol 1998;82(8):911-5
21. Lin AA, Buckley EG. Update on pediatric cataract surgery and intraocular lens implantation. Curr Opin Ophthalmol. 2010; 21(1): 55-9. DOI: 10.1097/ICU. 0b 013e 32833383cb.
22.  Khokhar SK, Pillay G, Agarwal E, Mahabir M. Innovations in pediatric cataract surgery. Indian J Ophthalmol. 2017;65 (3):210-216. DOI: 10.4103/ijo. IJO_860_16.
23.  Khokhar S, Gupta S, Yogi R, Gogia V, Agarwal T. Epidemiology and intermediate-term outcomes of open- and closed-globe injuries in traumatic childhood cataract. Eur J Ophthalmol. 2014 Jan-Feb;24(1):124-30.
24. Peleja MB, da Cunha FBS, Peleja MB, Rohr JTD. Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil. BMC Ophthalmol. 2022 Mar 09;22(1):111.
25.  Baur ID, Auffarth GU, Łabuz G, Khoramnia R. [Implantation of a Toric IOL with Enhanced Depth of Focus for Unilateral Traumatic Cataract]. Klin Monbl Augenheilkd. 2023 Jun;240(6):819-823.