Visual Outcome Predictors in Traumatic Cataract: A Prospective Study Using Betts Classification and Ocular Trauma Score
Abstract
Aim: Traumatic cataract presents unique surgical challenges and strategic management is essential to achieve optimal visual rehabilitation. This study evaluates visual outcomes and identifies probable predictors of visual prognosis in traumatic cataract. Materials and Methods: This prospective, observational, single-institution study included 43 consecutive patients with traumatic cataract. All patients underwent detailed history and clinical examination and were classified according to the Birmingham Eye Trauma Terminology System (BETTS). Visual prognosis was estimated preoperatively using the Ocular Trauma Score (OTS). Management was tailored to the type of injury, capsular status and associated ocular co-morbidities. Patients were followed for a minimum of six months. Primary and secondary surgical interventions were recorded and final Best-Corrected Visual Acuity (BCVA) was correlated with initial OTS predictions. Results: Of 43 patients (mean age 24 years; range 8 months-68 years), 38 (88.4%) were male. Open-globe injuries (n=29, 67.4%) were more common than closed-globe injuries (n=14, 32.6%). The commonest causative agents were iron rod and wooden splinter (each 16.3%). Corneal tear (60.5%) was the most frequent associated co-morbidity and significantly influenced final visual outcome. Penetrating injuries had the poorest recovery, with 56% achieving vision <1/60. Contusion injuries had the best recovery, with 46.2% achieving 6/36-6/18 and 30.8% achieving ≥6/12. Thirty-nine patients (90.7%) were OTS category 2. Comparison of six-month BCVA with OTS-predicted outcomes showed concordance in most categories, with better-than-predicted results in OTS categories 1, 2 and 3 for higher vision bands. Conclusion: Systematic classification using BETTS and prognostication with OTS are valuable preoperative tools in traumatic cataract. Associated co-morbidities-particularly corneal scarring, vitreous haemorrhage, retinal detachment and aphakia-are critical predictors of poor visual outcome. Tailoring primary and staged secondary procedures to the injury pattern improves visual rehabilitation and allows realistic counselling.