Clinical and Epidemiological Aspects of Traumatic Cataracts in Children at CHU Campus of Lome

Socio-demographic aspects

The mean age of patients was 7.70 ± 3.64 years [1.1years-15 years]. The age group between 5 and 10 years was the most represented, with 47.50% of patients. We counted 48 male and 32 female patients, that is a sex ratio of 1.5 (figure 1).

Fifty percent of children attended primary school, 27.50% secondary school and 22.50% had no education.

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IAB = intentional assault and battery. RTA = road traffic accident.

The trauma was blunt in 57.50% and penetrating in 42.50%. The most common vulnerating agent was wood in 29.48% of cases, followed by a punch in 26.93%, a knife in 11.54% and a catapult in 11.54%. Children who consulted within the first 72 hours represented 35%, followed by those who consulted between 72 hours and 1 week, 25% (Table 2).

Traumatic cataracts in children were all unilateral, with 45% in right eyes and 55% in left eyes.

Visual acuity was reduced to positive light perception (PL+) in 28.75% of cases, and ≥ 3/10 in 5% of cases. The majority of patients had low vision on admission ≤ 1/10th, i.e. 51.25% of cases (Table 3).

VA= Uncorrected visual acuity, RE= right eye, LE = left eye LP- = no light perception, LP+= light perception.

Anatomically, according to the type of the traumatic cataract in children, total cataract was the most represented, with 70.59% of cases, followed by anterior subcapsular, cortical and posterior subcapsular cataracts in 14.71%, 8.82% and 5.88% respectively. Traumatic cataracts were without capsular rupture in 85% of cases. Traumatic cataracts were non-dislocated in 93.75%, subluxated in 3.75% and dislocated in the vitreous body in 2.50%.

Corneal wound was the most common associated injury in 17.50% of cases, followed by corneal edema in 15% (Table 4).

Injuries to the iris were associated with cataracts in 51.25% of cases, and dominated by synechiae in 17.50% of cases.

As the fundus is inaccessible, injuries of the posterior segment are objectified by a B-scan ocular ultrasound. The B-scan ultrasonography showed posterior vitreous detachment, vitreous hemorrhage and retinal detachment associated with traumatic cataract in 17.39%, 13.04% and 10.87% of cases respectively.

Socio-demographic

The study of the age distribution showed a predominance of children aged between 5 and 10 years in 47.50% of cases. The mean age of patients was 7.70 years, as reported in the studies by Kharbouch, et al. [6] and Jinagal, et al. [7], respectively 7.76 and 7.67 years. That age group between 5 and 10 years is the one in which children have more freedom of movement, are curious and have less awareness of danger. Boys were the most affected in our study, with 60% of cases [8]. Male predominance has also been noted by several authors [9, 10]. This male predominance could be explained by the turbulent behavior of boys, who are more often involved in risky activities than girls.

Clinical

The circumstances of ocular trauma responsible for traumatic cataracts were recreational accidents in 32.50% of cases. This result is similar to that of studies with proportions of 35% and 38.82% [11, 12]. The literature review reports higher rates such as 75.7% and 65% [6, 13]. All these authors agree that play in the absence of adult supervision is the main cause of ocular trauma in children, and that play is the child’s main intuitive activity. In this series, 57.50% of patients had predominantly blunt trauma, as noticed in studies from the West African

sub-region, with rates between 92.8% to 94.7% [2, 5]. On the other hand, in studies from Tunisia, perforating mechanism dominated, with rates of 56.2% and 55% [4, 14]. Are children in sub-Saharan Africa less violent than those in North Africa? The most commonly reported vulnerating agent was wood in 29.48%. Plant body is easily accessible in our countries and is present in our daily activities, what explains that it is the most frequently reported vulnerating agent.

Thirty-five percent of our patients consulted within the first 72 hours after the trauma. The time before consultation in the series was dominated by that between 1 month and 1 year, with 36% of cases after the trauma [11]. This relatively short time before consultation in our study may be linked to the accessibility of ophthalmology infrastructures in an urban area, and to the study setting. Indeed, CHU campus is the reference center for pediatric eye diseases.

Anatomically, according to the type of traumatic cataract, total cataracts were most represented in 70.59%. This result is close to the 75% found by Baklouti, et al. [14].

Visual acuity was less than 1/10 in 51.25% of cases. Initial low vision between 82 and 95% has been reported by several authors [6, 13]. Unilateral low vision in children with traumatic cataracts could be explained by the fact that most of them were total, sometimes with associated eye injuries. These children are at risk of amblyopia, which seriously jeopardizes their functional visual prognosis.

The associated injuries were of all kinds, and corneal wound is the most frequently found in 17.50% of cases. Kharbouch et al. [6] and Baklouti et al. [14] found respectively 80.3% and 55% for corneal wound. The literature notes that the cornea remains the most injured structure of the eyeball in cases of ocular trauma [15, 16, 17]. This is understandable, since the cornea is the outermost structure of the eyeball, in direct contact with the external environment. It is therefore immediately exposed to any form of aggression from the external environment. Posterior segment injuries associated with traumatic cataracts in children, as detected by the B-scan ocular ultrasound, were dominated by vitreous hemorrhage and retinal detachment in 13.04% and 10.87% of cases respectively. Studies have found the same posterior segment injuries, but in varying proportions [4, 6].