Ophthalmological manifestations, visual outcomes, and treatment of electrical and lightning trauma: A Systematic Review.

Purpose: Electrical and lightning injuries are rare but carry significant risks for ocular complications. This systematic review aims to synthesize data on ocular manifestations, visual outcomes, and treatment approaches following such traumas.

Methods: A comprehensive literature search was conducted up to August 21, 2023, utilizing PubMed, Embase, and Web of Science databases. Observational studies, including case reports, case series, and cross-sectional studies involving patients with electrical and lightning injuries, were included. Quality and risk of bias were assessed using the Hoy et al. tools for cross-sectional studies and the Hassan Murad et al. recommendations for case reports and series. Data on ocular manifestations, visual outcomes, and administered treatments were extracted. Manifestations were compared across high-voltage (≥ 1000 V) and low-voltage (< 1000 V) exposures. Visual outcomes were classified into no visual impairment (Best Corrected visual acuity [BCVA] better than 0.4 LogMAR), any vision impairment (BCVA of 0.4 LogMAR or worse), and legal blindness (BCVA of 1.0 LogMAR or worse). This review is registered with PROSPERO (CRD42023453495).

Results: The review included 71 studies comprising 183 patients. Cataracts were the most common anterior segment finding (30.05%), and macular cysts were the predominant posterior segment finding (10.38%). Visual outcomes reported for 56 patients showed that 51.35% experienced some degree of visual impairment, with 33.92% classified as legally blind. High-voltage exposure was associated with a higher frequency of cataracts (82.35% vs 37.50%) and macular cysts (11.76% vs. 0%) compared to low-voltage injuries. Patients with legal blindness more frequently exhibited cataracts (73.68% of legally blind patients vs. 61.29% with some visual impairment vs. 56.0% with no visual impairment) and macular cysts (26.32% of legally blind patients vs. 12.0% with no visual impairment). Surgical interventions such as phacoemulsification (15.85%) and vitrectomy (6.02%) were conducted.

Conclusion: Electrical and lightning injuries can lead to significant ocular complications; the frequency of those complications varies according to the voltage of exposure and the resulting visual outcomes, occurring more frequently in patients exposed to high voltages and those who are legally blind.