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Michael P. Smith, Marcus Colyer, Michael J. Mines, Richard Stutzman; Primary versus Secondary Intraocular Lens Insertion in Traumatic Cataract Patients at Walter Reed Army Medical Center. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6653.
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To compare visual outcomes, surgical interventions and injury characteristics in military personnel undergoing primary or secondary intraocular lens (IOL) insertion as a result of traumatic cataracts sustained from combat ocular trauma.
A retrospective comparative case series of United States military personnel treated at Walter Reed Army Medical Center (WRAMC) who sustained traumatic cataracts from combat ocular trauma and underwent primary or secondary IOL insertion from March 2003 to December 2010. Primary outcomes are LogMar visual acuity at 6 months and at final follow-up. Secondary outcome was spherical equivalent. Thirty three other variables were compared including ocular trauma score, initial lens status and types of surgical intervention.
Records of 200 eyes of 183 patients sustaining traumatic cataracts were reviewed. 31 eyes of 30 patients underwent primary IOL insertion and 25 eyes of 21 patients received secondary IOLs. The average ocular trauma score in the primary IOL group was 70.6 (range 47-90) and 66.4 (36-100) in the secondary IOL group (p=0.18). In the primary group, 17 IOLS (55%) were inserted into the capsular bag and 13 IOLs (42%) into the ciliary sulcus. 1 anterior chamber IOL was inserted. In the secondary IOL group, 1 IOL (4%) was placed in the capsular bag, 12 IOLs (48%) were placed in the ciliary sulcus, 11 IOLS (44%) were sewn in and 1 IOL was placed into the anterior chamber. Initial pre-operative LogMar visual acuity in the primary IOL group was 1.53 +/- 0.82(4 Light Perception vision (LP)) and 2.59 +/- 0.88(11 LP) in the secondary IOL group (p=0.43). Six months post-operatively, average LogMar visual acuity in the primary IOL group was 0.677 +/- 0.79 (with 4 LP)and 0.516 +/-.64 (p=0.55) in the secondary IOL group. At final follow-up, visual acuity in the primary IOL group was 0.714 +/- 0.87 (with 1 NLP and 1 LP) and 0.523 +/-0.82(with 2 LP) (p=0.62)in the secondary IOL group. Post-operatively, the average spherical equivalent was -0.96 +/-1.71 diopters in the primary IOL group and -0.60 +/- 1.26 diopters (p=0.46) in the secondary IOL group. Average follow-up time was 1147 days in the primary IOL group and 1025 days in the secondary IOL group.
Only slightly more than one quarter of eyes sustaining combat ocular trauma with traumatic cataract eventually undergo intraocular lens insertion. While there are many factors that play a role in surgical planning and decision making, ultimate visual and refractive outcomes in eyes undergoing primary IOL compared to secondary IOL insertion are similar.
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