Spontaneous Resolution of a Traumatic Cataract in Cerebral Palsy Libyan Patient

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Introduction
The rate of surgery in eastern Mediterranean countries remains low. The provision of widespread cataract surgery delivered in a timely fashion before individuals are visually impaired by this condition may result for a reduction of blindness and visual loss.
A related disturbing issue is the frequency with which ophthalmic surgery results in intra operative or postoperative complications. In several eastern Mediterranean countries, the rate of complications following cataract surgery remains high. The recent introduction of new techniques for cataract surgery, including phacoemulsification, has been started by ophthalmologists in eastern Mediterranean countries. Despite these advances, less than 20% of the cataract surgery in eastern Mediterranean countries is phacoemulsification. This is because of lack of resources in certain areas for cold and emergency cases, the presence of corneal scars, and advanced mature cataracts [1].

Discussion
Although in traumatic cataract, cataract extraction, usually in combination with intraocular lens implantation, is required for vision correction [2,3]. Spontaneous resolution of posterior cortical cataract (PCC) has been reported previously in cases where the cataract is caused by uncontrolled acute hyperglycemia [4] In the case of traumatic cataracts, spontaneous reversal of PCC mainly occurs with mild or limited ocular injury, such as mild blunt contusion or small intralenticular foreign body [5,6]. or transient feathering of the lens after intraocular gas tamponade [7]. In severe open-globe ocular injury cases, spontaneous resolution of extensive dense PCC is rare [8], However, if the lenticular capsule damage is limited, the proliferative lens epithelium can reseal the wound without progressive cataract formation, and in rare cases, allow cataract resolution [5]. The lens epithelium and fiber cells become spontaneous regression [11]. Paradoxically, in our case, cataract density was worst at the posterior cortex and not the anterior part of lens. Previous reports indicate that in blunt ocular trauma, posterior capsular rupture is more likely to appear in children and young adults [12,13] Wolter proposed that the absence of a sclerotic nucleus and strong zonular fibers in children and teenagers may allow the force of impact to transmit to the posterior part of lens [14]. In open-globe injury cases, cataract formation results from direct impact, and the location of the most dense opacity commonly indicates the point of greatest impact [3,11].
We hypothesize that in this open-globe injury case, the PCC is secondary to indirect shock waves stemming from impact. In young cataract patients, treatment options are more debated and require further consideration. It is known that the critical period of eye development ranges from 2 to 6 months of age, and emmetropization is generally achieved by 9 years of age [15]. To avoid amblyopia, some ophthalmologists recommend early surgical intervention for pediatric ocular traumatic cataracts, and in simple PCC cases without corneal or retinal injury, cataract extraction with intraocular lens implantation can restore excellent visual acuity [2,16]. However, in young patients, cataract extraction also results in the loss of accommodation. For children, loss of accommodation and physiologic hyperopic reserve might affect the progress of emmetropization [17]. For teenagers, this loss of accommodation aggravates asthenopia during near work in daily life.
Trauma is a cause of monocular blindness in the developed world, although few studies have addressed the problem of trauma in rural areas. The aetiology of ocular injury in rural areas is likely to differ from that in urban areas and is worthy of investigation [18]. Any strategy for prevention requires knowledge of the cause of injury, which may enable more appropriate targeting of resources towards preventing such injuries. Eye trauma represents a large, potentially preventable burden on both victims and society as a whole [19]. Importantly, conservative observation may greatly benefit the young patient by avoiding unnecessary invasive surgical intervention, and its complication and subsequent loss of vision.