NEOVASCULARISATION OF THE LENS CAPSULE: A UNIQUE FINDING

To report and discuss  a case of neovascularisation of the lens capsule associated with proliferative diabetic retinopathy.

Mohammed V University, University Hospital Ibn Sina Rabat, Departement A of Ophthalmology, Morocco 

we conducted a full clinical evaluation with ancilliary testing mainly a fundus fluorescein angiograpgy. we documented the findings by slit-lamp photography and scans. we also performed a cataract surgery by phacoemulsification

A 62 year-old man consulted for progressive loss of vision in both eye. His past ophthalmological history was unremarkable and he denied any known systemic condition. On examination, his best corrected visual acuity was light perception OU. Papillary reaction to light was sluggish OS and normal OU. Ocular motility was full OU with normal intra-ocular pressure. Slit-lamp examination showed bilateral white mature cataract with low pharmacological dilation. High magnification under dilation revealed a vascular network composed of fine vessels located nasally adjacent to the papillary border on the anterior capsule of the lens associated with pigment deposits and loss of the papillary frill (figure 1 a). There was no evidence of neovascularisation of the iris (NVI) or the angle (NVA). Ocular ultrasound was negative for vitreous hemorrhage or retinal detachment.

Ancilliary testing for diagnosis of common aetiologies of anterior segment neovascularisation was carried out and revealed type 2 diabetes. The patient was referred for evaluation and control of his newly diagnosed diabetes.

After six months, we performed an uneventful cataract surgery by phacoemulsification. Fundus fluorescein angiography (FFA) showed posterior segment ischemia with neovascularisation elsewere (figure 1 b).

Neovascularisation of the lens capsule (NVC) is a rare finding theoretically driven by an up-regulation of angiogenic factors such as vascular endothelial growth factor (VEGF) secondary to chronic ischaemia. It may be the solely sign of ischemia in the absence of NVI or NVA especially when the fundus examination is inaccessible.  Few cases were reported and emphezised that one should perform a complete clinical evaluation and workup for diagnosis of aetiologies of anterior segment neovascularisation before considering NVC an isolated finding.

 

To our knowledge, this is the first reported case of NVC associated with proliferative diabetic retinopathy. Neovascularisation spared the iris and the angle. Thus, NVC was the solely sign of anterior segment neovascularisation.