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Spontaneous lens dislocation in hypermature cataract

Poster Details


First Author: S.Petrovic Pajic SLOVENIA

Co Author(s): P. Schollmayer   X. Lumi   M. Hawlina              

Abstract Details

Purpose:

Spontaneous posterior capsule rupture with lens-nucleus dislocation is a very rare entity. In the available literature there are few such cases described in hypermature senile cataract with or without accompanying inflammatory reaction, in posterior polar cataracts, Marshall syndrome and in pseudoexfoliation (PEX) syndrome. We report an unusual case of spontaneous nucleus dislocation with unexpected development during nine months follow-up period in a 79 year-old female. Patient reported no history of trauma or eye diseases. General medical history was insignificant. She had uneventful cataract surgery in Germany on the left eye 13 years ago.

Setting:

The patient was referred to Eye Hospital by local ophthalmologist because of intermittent pain and progressive visual loss on the right eye due to luxated nucleus and high intraocular pressure of 50 mm Hg. IOP initially responded to treatment and was reduced to 22 mm Hg in two days.

Methods:

On admission, uncorrected visual acuity on the right eye was counting fingers on 20 cm and 20/20 with aphakic correction. IOP was normal. Cornea, anterior chamber and vitreous were clear. Gonioscopy was normal with no signs of PEX. Capsular bag was clear without cortex, with rolled-up anterior and posterior lens capsule. Nucleus was found in the vitreous at the equator at 6 o’clock. Optic disc was normal. OCT showed initial epimacular membrane. Immediate surgery was suggested, however, period of 3 months was needed to arrange her foreign insurance. During this time patients’ IOP increased and cystoid macular oedema with lamellar macular hole developed.

Results:

Patient underwent pars plana vitrectomy with phaco fragmentation of the nucleus and epiretinal membrane peeling. At this stage the eye was left aphakic. On the second postoperative day macular morphology was normal according to OCT, best corrected visual acuity was 20/40 and the IOP was normal under topical therapy. One month after the surgery the eye was without any signs of inflammation but IOP started to rise again with peaks over 30 mm Hg and CME returned. At the last visit three months postoperatively IOP was 24 mm Hg despite maximal topical and oral therapy and OCT showed full thickness macular hole.

Conclusions:

Spontaneous lens capsule rupture in hypermature cataracts is extremely uncommon in urban patients nowadays. The mechanism of capsular rupture in our case remains unknown. It was unusual to find clear lens capsule in the quiet eye with normal visual acuity with aphakic correction which rapidly deteriorated in the direction of intractable secondary glaucoma and CME with development of full thickness macular hole despite uneventful surgery, NSAID and steroid treatment. Such unexpected evolution has not yet been described in available literature and suggests possible autoimmune reaction to lens proteins and importance of early removal of the dropped nucleus.

Financial Disclosure:

None

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