Case Report - (2023) Volume 10, Issue 4
Received: Jan 05, 2023, Manuscript No. JEBMH-23-85632; Editor assigned: Jan 09, 2023, Pre QC No. JEBMH-23-85632 (PQ); Reviewed: Jan 23, 2023, QC No. JEBMH-23-85632; Revised: Mar 22, 2023, Manuscript No. JEBMH-23-85632 (R); Published: Sep 29, 2023, DOI: 10.18410/jebmh/2023/10/03/91
Citation: Haque OI, Siddiqui Z, Abdullah A. A Case Series of Electric Cataract. J Evid Based Med Healthc 2023;10(2):73.
Electrical insults can result in a wide range of ocular injuries with resultant ocular complications. The cataract is believed to occur due to coagulation of lens proteins and the increased osmotic permeability changes following damage to the sub capsular epithelium. Intra-operative challenges in electric cataract include increased risk of Argentinian flag sign due to increased intralenticular pressure due to the maturation of cortical fibers. Phacoemulsification or traditional mSICS followed by in the bag implantation of posterior chamber intraocular lens resulted in stable and good visual acuity as witnessed in these cases.
Cataract, Electric cataract, Intralenticular pressure, Epithelium, Cortical fibers
Electrical insults to the human body can cause wide array of disorders ranging from death to damage to various parts of the body. It is not uncommon to encounter electrical injuries in developing nations like India. In the eye it can result in a wide range of ocular injuries with resultant ocular complications of these, electrical cataract can occur after a latent period and then can progress rapidly.1,2However, proper surgical management can result in good and stable visual acuity, as seen in this case series. Electric cataracts are uncommon mostly owing to the fact that there only few survive after high tension electricity to witness complications such as cataract. Here we report two cases of cataracts caused by electric current.
Case 1
A 16 year old male patient, a rickshaw driver by occupation, reported to eye department of J.N.M.C.H, Aligarh after 1 year of electric injury due to direct contact of high tension wire falling on his head with complaints of painless progressive diminution of vision in both eyes. On examination, there was a post-burn scar on the scalp, neck, chest and both legs. The best corrected visual acuity was counting fingers at 1 meter in both eyes. Slit lamp examination showed anterior sub capsular cataract, right more than left, in both eyes. Indirect ophthalmoscopy and optical coherence tomography could not be done due to inadequate media clarity. For the right eye, phacoemulsification with foldable hydrophobic PCIOL implantation in the capsular bag was performed under topical anesthesia. Intraoperative the anterior chamber became shallow, and there was spontaneous capsular tear extending to the periphery (Argentinian flag sign). The capsulorhexis was completed with Utrattas forceps and scissors. Postoperatively the recovery was uneventful. He regained uncorrected visual acuity of 6/9, N6 in the right eye (Figures 1-4).
Figure 1. Pre-op Right Eye on Diffuse Illumination Showing opacities in the Sub-Capsular Cortex.
Figure 2. Pre-op Right Eye on Slit Lamp Showing Predominantly Anterior Sub-Capsular Cataract.
Figure 3. Pre-op Left Eye on Diffuse Illumination Showing opacities in the Sub-Capsular Cortex.
Figure 4. Pre-op Left Eye on Slit Lamp Showing Predominantly Anterior Sub-Capsular Cataract.
The left eye was operated a week later under extreme precautions to minimize the risk of capsular tear. Oral glycerol syrup and Acetazolamide (Diamox) tablets thrice a day were started a day before surgery to bring down the IOP. The surgery was uneventful and the patient gained uncorrected 6/9 vision in the immediate post-op period, which improved to 6/6 vision with a correction of +0.5 X 180° on day three post-operatively.
Case 2
A 35 year old female patient, home maker by occupation, reported to eye department after eight years of electric injury due to direct contact of high tension wire falling on his head with the complaints of painless progressive diminution of vision in the right eye. The left eye was operated six months following the initial insult in a private set up and the uncorrected visual acuity was 6/6 in the left eye. On examination, there was a scar of entry wound on the scalp, and exit wound scar on legs. Scalp wound was operated eight years back. Best corrected visual acuity was counting fingers at 1 meter in the right eye. Slit lamp examination showed anterior sub capsular cataract in the right eye and pseudophakia with normal fundus in left eye. Indirect ophthalmoscopy and optical coherence tomography could not be done due to hazy media in right eye. Rest of the ocular examination and systemic examination was within normal limits in both eyes (Figures 5-7).
Figure 5.Scar of Entry Wound on Scalp
Figure 6. Scar of Exit Wound on Left Leg.
Figure 7. Slit Lamp Examination Showing Multiple Anterior Capsalar and Sub-Capsalar Opacities Along with Nuclear Sclerosis
For the right eye, due to financial constraints, Manual Small Incision Cataract Surgery (MSICS) with foldable hydrophobic PCIOL implantation in the capsular bag was performed under the peri bulbar block. Intraoperative course was uneventful. Postoperatively the recovery was uneventful except for the initial rise in IOP (42 mmHg). She was started Acetazolamide 250 mg tablets thrice daily and Glycerol syrup thrice daily. She regained uncorrected visual acuity of 6/9 in the right eye post-op day 1 with an IOP of 42 mmHg measured by non-contact tonometry. Oral acetazolamide tablets (Diamox) thrice a day for one week was started to control the IOP, which normalized a week later to 18 mmHg.3-5
High voltage electric burns can cause various ocular injuries and may manifest in the form of conjunctival hyperemia, corneal injuries either due to primary injury of electric current or developing secondary to complications such as lid fibrosis, trichiasis, entropion etc., iris injuries mainly in the peripheral iris as current passes through that region, zonular injury, macular hole, choroidal atrophy primarily due to RPE atrophy as RPE being the outer most layer suffers the greater brunt of electric current. Uveitis, miosis, spasm of accommodation, cataract, retinal edema, papilledema, retinal detachment and optic atrophy, choroidal rupture, optic neuritis, and retinal detachment may also be seen. Macular edema may progress to macular cysts or holes.6-8
The cataract is believed to occur due to coagulation of lens proteins and the increased osmotic permeability changes following damage to the sub capsular epithelium. While the coagulative changes develop immediately following the insult, osmotic changes usually develop 1–12 months after the electric shock. Opacities form in the capsule and in the anterior sub capsular cortex. The posterior cortex may also be affected. The progression of the cataract varies from case to case. It may remain stationary for a long time or progress slowly over six months to become a mature or hyper mature cataract. Rarely may it cause phacomorphic glaucoma. Electric burns can sometimes be noticed as a sharply defined mark at the point of contact. The amount and rapidity of changes in the lens seem to bear no relation to the strength of the current. The lens in younger patients is more liable to damage than that of old age.
Intra operative challenges in electric cataract include increased risk of Argentinian flag sign due to increased intralenticular pressure due to the maturation of cortical fibers. Capsular fibrosis due to electric injuries can cause difficult manipulation of the capsule. These risks can be minimized by using osmotic ocular hypotensives such as Acetazolamide and glycerol pre-operatively. Per op the use of high density viscoelastic and micro instruments (<1 mm incision instruments) can be very helpful in preventing complications. In most cases developing a cataract, the electric current has passed through the head near the eye. Phacoemulsification or traditional mSICS followed by in the bag implantation of posterior chamber intraocular lens resulted in stable and good visual acuity as witnessed in these cases. Capsulorrhexis may be difficult with a high probability of Argentinian flag sign owing to increased intra lenticular pressure due to the maturation of cortical fibers. Thus, proper surgical management of electric cataract will result in a good visual rehabilitation if the eye has no additional damage as in this case.
All authors have none to declare.
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