Cataract after electrical injury: clinical characteristics and surgical management outcomes, a case report of three cases

Electric cataract, a rare and vision-threatening complication, is frequently observed in patients following electrical injuries. Current knowledge of its clinical characteristics and treatment is largely derived from a limited number of case reports. This report presents three cases of distinct types of electric cataract, with detailed documentation of disease progression, clinical features, individualized surgical management, and corresponding outcomes. This case series included three patients: a 30-year-old female with indirect lightning-induced cataract (onset at 2 years), a 64-year-old male with cataract following domestic low-voltage electrical injury (onset at 50 years), and a 54-year-old male with high-voltage electric cataract (onset at 3 months). All three cases presented with characteristic anterior subcapsular opacities (snowflake, sunflower, or moss-like patterns), anterior subcapsular cortical opacities, and posterior subcapsular opacities. Intraoperative zonular laxity was observed in all three cases. Two patients had unilateral involvement, while one had bilateral cataracts. The young patient received implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL), and the middle-aged patient received implantation of a toric monofocal IOL. The patient with bilateral cataracts also had simultaneous macular damage, as well as corneal leukoma; a monofocal IOL was implanted in one eye, while the fellow eye ultimately progressed to a mature cataract. Postoperative corrected distance visual acuity improved to 0.8 in two cases and 0.4 in the third. No significant postoperative complications were observed. Cataracts following electrical injury may be insidious at onset and can exhibit progressive worsening. Pupillary dilation examination is essential, and regular follow-up is required. Attention should be paid to concomitant injuries of the cornea, fundus, zonules, and corneal endothelium to guide individualized surgical planning, thereby maximizing patient benefits.