A 10-Year Clinical Audit on Traumatic Cataract Surgery in a Tertiary Center in Malaysia: A Retrospective Cohort Study

To determine the prevalence of traumatic cataract and factors influencing visual outcomes following cataract extraction in a tertiary center in Malaysia.

A retrospective review was conducted on patients treated for traumatic cataract at the ophthalmology department between January 2012 and December 2022. Data were retrieved from the Malaysian Cataract Registry. Data of those with history of blunt trauma, secondary cataract surgery, or primary closure with cataract removal after open globe injuries, with a minimum 1-year follow-up after surgery, were extracted from the registry. Their data were retrieved from the medical record unit. The outcome of cataract surgery was based on best-corrected visual acuity (BCVA) ≥6 / 18 as good and <6 / 18 as poor outcome.

A total of 224 patients (113 with open globe injuries and 112 with closed globe injuries) were included, with a mean age of 41.1 ±19.8 years. Men had a 5:1 higher risk. Domestic accidents (34.4%) were the leading cause, followed by agricultural (21.9%) and nonagricultural occupational injuries (21.4%). Preoperatively, 72.8% presented with severe visual impairment. Phacoemulsification was the most common surgical technique (37.1%), and primary intraocular lens (IOL) implantation was performed in 53.1%, while 25.9% remained aphakic. Postoperatively, 46.0% achieved BCVA ≥6 / 18, while 24.1% remained blind (<3 / 60). Those with closed globe injuries were 3.4 times more likely to yield good visual outcomes (p < 0.001). Better preoperative visual acuity, posterior capsule IOL, sulcus- and iris-fixated IOL is associated with favorable outcome. There was significant correlation between preoperative and postoperative visual acuity (r = 0.306, p < 0.001).

Traumatic cataract surgery is not uncommon, but the outcome is unpredictable. Closed globe injuries, better preoperative visual acuity, posterior capsule IOL, and sulcus- and iris-fixated IOL are strong predictors for favorable visual recovery in traumatic cataract surgery. Early intervention, thorough ocular assessment, and tailored surgical planning are crucial for optimal rehabilitation.