Author Communication
Bilateral Post-electrocution Cataract
Anum Javed, Owais Arshad, Javeria Nasir, Mohammad Hanif Chatni
DOI
10.36351/pjo.v35i4.929 Pak J Ophthalmol 2019, Vol. 35, No. 4
. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
|
See end of article for authors affiliations
..
.. Correspondence to: Dr. Owais Arshad Ophthalmology Department, Patel Hospital, Karachi, Pakistan Email: owaisarshad17@gmail.com |
Trauma from electricity can be of multiple forms, ranging from
mild damage, to life-threatening conditions like cardiac arrest. Ophthalmic
injuries are not uncommon following electrocution. We report a case of post
electrocution cataract in a 24-year old male who presented to us three years
after injury. On examination his best corrected visual acuity was 1/60 in the
right eye and hand movement in the left eye. Slit lamp examination revealed a
white, mature cataract in the left eye and a developing anterior capsular
cataract in the right eye. B-scan of left eye was normal. Fundoscopic
examination of right eye was normal. Left cataract surgery was done.
Per-operatively, the capsulorhexis was surgically challenging due to the
adherence of the cataract with the anterior capsule. The BCVA in the left eye
was 6/6 postoperatively. Key Words: Electric Injury, Cataract,
Phacoemulsification. |
Electricity related injuries are more common in developing
countries like Pakistan as compared to the developed world1. Effects
of electric current entering the body are a result of inflow of charges on the
molecular and sub-molecular level, generating thermal energy causing
disturbance of cellular physiology.
The
consequences may involve any part of the body and the eyes are no exception. Cataract
induced by electric current may present much later with respect to the time of
injury, with rapid progression and diminishing vision2. We report a
case of post-electrocution cataract in a young male.
CASE REPORT
A 24-year
old male presented to the outpatient eye department of Patel hospital with
complaint of decreased vision in both eyes for the past five months. His
symptoms were more in the left eye. On enquiring the detailed past history he revealed
that he was electrocuted 3 years ago from high tension wire affecting the left
side of his body. On physical examination, there was a wound of electrical
injury on the left palm. BCVA in the right eye was 1/60, and Hand Movement in
the left eye. Slit lamp examination showed a white, mature cataract with
adherent central plaque to the anterior capsule in the left eye as shown in Figure
1 (left side). In the right eye, there was also a developing anterior sub
capsular plaque like cataract similar to the left eye (Right side of figure 1).
Fig. 1 (Left): White,
mature cataract in the left eye, adherent to the anterior capsule.
(Right): Cataract developing in the right eye.
Dilated
fundus examination of right eye was normal. B-Scan ultrasound was done which
showed a flat retina. Left cataract surgery was planned. During phacoemulsification,
the anterior capsule was adherent with the underlying cortex forming a plaque. Capsulorhexis
was extended towards the zonules and typical Argentinian flag sign was observed
but the situation was managed and acrylic soft hydrophobic posterior chamber
intra-ocular lens (PC-IOL) was implanted in the bag under general anesthesia. Postoperatively,
unaided vision in the left eye was 6/6 with normal fundoscopic findings on
2-weekly follow-up. Right eye surgery was also planned in the following month. Informed
consent was obtained from the patient for reporting this case.
DISCUSSION
Ocular post electrocution injuries include entities like cystic
macular edema/macular cyst, iritis, anisocoria, chemosis and corneo-epithelial
keratitis. Among these, lens is particularly more vulnerable to electric current.
Therefore, cataract remains the commonest form of electrical ocular injury.
There are several factors, which are responsible for the variable
manifestations and features of these pathologies including location and
orientation of body tissues in the current path, duration of electric current
as well as its amperage, voltage and resistance3.
Etiology of electric cataract is unknown but thought to be related
to the protein coagulation in the lens that occurs after an electric shock. Worldwide,
post-electrocution cataract occurs in 0.8% of the population4. Even
there is high prevalence of electrocution cases in our country, but due to lack
of awareness and increased mortality, very few cases have been reported.
Duration in which the visually significant cataract develops ranges
from 1-18 months5 as in our case, the patient presented after three
years of latent period following injury. Patient usually remains asymptomatic
for a long duration with subsequent decreasing vision over a short period of
time, as cataract approaches the visual axis, like in our case.
Morphologically
the cataract starts as a vacuolar appearance in the mid-periphery of the lens
which may be easily missed out in an undilated examination6. Cataract
in these cases, may have a strong attachment anteriorly and/or posteriorly with
the capsule, making it a surgical challenge7. In our case also, due
to the adherent nature of the cataract to the capsule, it was forming a plaque
like appearance with cortical spokes. Surgically, it is possible to extract
this cataract via phacoemulsification with PC-IOL, provided it is performed by
a well-trained surgeon owing to the peculiar nature of this type of cataract. In
our case, the Capsulorhexis was difficult. The capsule was unidentifiable as a
separate entity due to its rubbery and adherent nature as found in other few
cases that are reported. PC-IOL is usually implanted after extraction of the
cataract provided that the capsule is intact. Post operatively, the visual
outcome is good5, in most of the cases as in our case.
CONCLUSION
Post
electrocution cataract may present late. Detailed history is important in
finding out the cause of pre-senile cataract. Cataract surgery of such patients
may be surgically challenging.
GRANT SUPPORT &
FINANCIAL DISCLOSURES
None.
REFERENCES
1.
Zeb A, Arsh A, Bahadur S, Ilyas SM. Spinal cord injury due to fall from electricity
poles after electrocution. Pak J
Med Sci. 2019; 35 (4): 10361039.
2.
Zhang L, Zhang K, Zhu YN, Wang QW, Yao K. Case report of unilateral electric cataract with
transmission electron microscopy image. Int J Ophthalmol. 2016; 9 (4): 636637.
3.
Fish RM, Geddes LA. Conduction of electrical current to and through
the human body: a review. Eplasty.
2009; 9: e44.
4.
Kasana RA, Baba PU, Wani AH. Pattern of high voltage electrical injuries in
the Kashmir valley: a 10-year single centre experience. Ann Burns Fire Disasters, 2016; 29 (4): 259263.
5.
Baranwal VK, Satyabala K, Gaur S, Dutta AK. A case of electric cataract. Med J Armed Forces India, 2014; 70 (3):
284285.
6.
Sofi R, Qureshi T, Gupta V. Electric cataracts: a cause of bilateral blindness
in Kashmir. Eye (Lond). 2018; 32
(10): 16761677.
7.
Kumawat Ramananda Sahay , et
al. Posterior capsular
rupture and spontaneous posterior dislocation of lens following electrical
injury.
Authors
Affiliation
Dr. Anum Javed
Resident
Department of
Ophthalmology,
Patel Hospital, Karachi,
Pakistan.
Dr. Owais Arshad
Senior Registrar
Department of
Ophthalmology,
Patel Hospital, Karachi,
Pakistan
Dr. Javeria Nasir
Registrar
Department of
Ophthalmology,
Patel Hospital, Karachi,
Pakistan
Dr. Mohammad Hanif Chatni
Consultant and head of
department
Department of Ophthalmology
Patel Hospital, Karachi,
Pakistan
Authors Contribution
Dr. Anum Javed
Manuscript Design, Writing
and final review.
Dr. Owais Arshad
Manuscript Design and
critical review.
Dr. Javeria Nasir
Manuscript Design and
Critical review.
Dr. Mohammad Hanif Chatni
Manuscript Design and Critical
review