|Year : 2020 | Volume
| Issue : 1 | Page : 34-36
A case of isolated bilateral cataract following high-voltage electrical injury
Ankur Yadav, Vishal Katiyar, Prateep Phadikar, Sanjiv Kumar Gupta
Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||05-Aug-2016|
|Date of Decision||07-Feb-2017|
|Date of Acceptance||25-Feb-2017|
|Date of Web Publication||17-Feb-2020|
Dr. Ankur Yadav
Department of Ophthalmology, King George's Medical University, Chowk, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
High voltage electric burns can cause various ocular injuries and may manifest in the form of conjunctival hyperemia, corneal opacities, uveitis, miosis, spasm of accommodation, cataract, retinal edema, papilledema, choroidal rupture, chorio-retinal necrosis/atrophy, retinal detachment and optic atrophy. The involvement of crystalline lens exclusively with sparing of other ocular structures is rare. We report a case of 16 year old male with bilateral total cataract after electrical injury by over-head high tension electric transmission cable accidentally falling on patient's head 6 months back. B scan showed no abnormality in both the eyes. The intra ocular pressure in both the eyes was within normal limits. Patient underwent lens aspiration with posterior chamber intraocular lens (PCIOL) implantation in both the eyes, under peribulbar anaesthesia (with an interval of 1 week between both the operations). Intra-operative and post-operative period were uneventful. Post operative BCVA was 6/6 in both eyes and fundus examination was within normal limits. Outcomes after surgery are very good if not associated with other ocular lesion like optic atrophy, chorio-retinal lesion, uveitis etc. This observation should encourage the ophthalmologist to undertake surgery for electric cataract, where necessary.
Keywords: Bilateral, cataract, electric current, Isolated
|How to cite this article:|
Yadav A, Katiyar V, Phadikar P, Gupta SK. A case of isolated bilateral cataract following high-voltage electrical injury. Oman J Ophthalmol 2020;13:34-6
|How to cite this URL:|
Yadav A, Katiyar V, Phadikar P, Gupta SK. A case of isolated bilateral cataract following high-voltage electrical injury. Oman J Ophthalmol [serial online] 2020 [cited 2020 Apr 3];13:34-6. Available from: http://www.ojoonline.org/text.asp?2020/13/1/34/278548
| Introduction|| |
Electrocution is a common occurrence in developing countries like India, where overhead high tension lines hang precariously near residential and office buildings. Although pushing the overhead electricity wires underground is the obvious, sure-shot, permanent solution to the danger of electrocutions, underground cable works are yet to be completed in many areas across the country. Electrical injuries to the human body range from death to damage to various parts of the body. High-voltage electric burns can cause various ocular injuries and may manifest in the form of conjunctival hyperemia, corneal opacities, uveitis, miosis, spasm of accommodation, cataract, retinal edema, papilledema, choroidal rupture, chorioretinal necrosis/atrophy, retinal detachment, and optic atrophy. Macular edema may progress to macular cysts or holes. Of these, electrical cataract can occur after a latent period and then can progress with startling rapidity. Although electric cataracts are uncommon, the need for awareness of the possibility of this complication and screening of all cases of electrical injuries is stressed. The majority of the cases respond well to surgery, but final visual acuity will depend on the other ocular damage due to electrical current. The involvement of crystalline lens exclusively with sparing of other ocular structures is rare. We report such a case of cataract caused by electric current. Proper surgical management resulted in good and stable visual acuity.
| Case Report|| |
A 16-year-old male reported to us with a 3-month history of painless, progressive diminution of vision in both eyes. There was a history of electric shock when a live 11 Kv electric transmission cable accidentally fell on his head 6 months back. This had resulted in burn injuries, alopecia with scarring on the scalp, and burn injuries in the neck region [Figure 1]. Burn injuries were managed in the “Department of General Surgery” of the university. The patient was visually asymptomatic till 3 months after the mishap when he noticed gradual fall in vision over the next 3 months. He presented to the Ophthalmology Outpatient Department, King George's Medical University with the visual acuity of perception of light with accurate projection of rays in all quadrants in both eyes. On anterior segment examination, the lids, conjunctiva, cornea, anterior chamber, iris, and pupil showed no abnormality, and there was bilateral total cataract [Figure 2]. Fundus was not visible at that time. B-scan showed no abnormality in both eyes [Figure 3]. The intraocular pressure in both eyes was within normal limits. Patient underwent lens aspiration with posterior chamber intraocular lens implantation in both eyes, under peribulbar anesthesia (with an interval of 1 week between both the operations). Intra- and postoperative period was uneventful. Postoperative best-corrected visual acuity was 6/6 in both eyes, and fundus examination was within normal limits.
|Figure 1: Alopecia with scarring on the scalp and contractures in the neck region due to burn injuries|
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|Figure 3: B-scan of both eyes showing bilateral cataractous lens with normal posterior segment|
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| Discussion|| |
Damage from electric current leading to cataract has been first documented in 1722 by St. Yves. Electric current as proved by Weeks and Alexander passes through the animal body as though it was passing through a structure-less gel, always choosing the shortest path from contact to contact without deflection by anatomical landmarks having an entry and exit wound. This causes unilateral cataract because current passes through a straight-line connecting wound of contact and wound of exit and the affected eye. Rarely, it may cause bilateral cataract, as in this case. The scalp burn in this case represents the entry wound for the electrical energy, but there was no clinically visible exit wound, in this case, making this case peculiar.
Cataract formation following electrical trauma has been reported to occur with a latency period varying from immediately after injury to a few years after injury. The exact pathogenesis of the effect of electric current on the proteins of the crystalline lens and the process of lenticular opacification is unclear. Hess and Croci proposed extensive epithelial damage as the cause of the lenticular opacities. Kiribuchi postulated that cataract was the result of uveitis and circulatory changes. Decreased permeability of the lens capsule, a direct coagulative effect on the proteins of the lens' cells, powerful contraction of the ciliary muscle causing a concussion type of cataract due to mechanical damage, nutritional disturbances of the lens due to iritis and impaired circulation, or ultraviolet and infrared irradiation could be causative factors in electric cataract. The progression of the cataract varies from case to case. It may remain stationary for a long time or progress slowly over a period of 6 months to become total or subtotal cataract as in this case. Rarely, it may cause phacomorphic glaucoma. The amount and rapidity of changes in the lens seem to bear no relation to the strength of the current. Furthermore, the lens in younger patients is more liable to damage than that of old age.
In conclusion, the involvement of crystalline lens exclusively with sparing of other ocular structures is rare. This case documents such a possibility. The excellent surgical results noted in both eyes of this patient are in keeping with the similar result reported by Portellos et al. This observation should encourage the ophthalmologist to undertake surgery for electric cataract, where necessary. Outcomes after surgery are very good if not associated with other ocular lesions such as optic atrophy, chorioretinal lesion, and uveitis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]