Unilateral Spontaneous Lens Absorption

The purpose of this presentation is to provide information about the unusual and rare condition that is unilateral spontaneous lens absorption in a patient with no other known systemic diseases. We found interesting to report this case in order to make ophthalmologists take this diagnose into account when visiting an aphakic patient without signs of cataract luxation to vitreous cavity, and absence of signs of previous surgery or trauma. Another interesting feature of this case is that the capsule is entire, as can be demonstrated with anterior segment OCT images. 

We also find important to rule out phacolytic glaucoma, produced by a trabecular mesh obstruction due to inflammatory molecules and lens proteins. 

Spontaneous lens reabsorption is a rare condition, which prevalence has been estimated of 1 of 10.000. 

Most of the described cases have been related to infectious or uveitic diseases, such as Rubella, Leptospirosis or Fuchs uveitis among others. The mechanism of action still remains unclear; in some cases an autoimmune reaction has been hypothesised, but has not been yet established. 

We present a case of a 34-year-old male referred to our centre with a complaint of blurry vision on his right eye that had been present for two years. He had history of mild cataract on his right eye, but had not undergone surgery. The patient denied any history of surgery, trauma or other associated symptomatology such as pain or redness. Neither other systemic diseases or family nor social histories were reported. 

On examination, right eye non-corrected visual acuity was counting fingers, and best corrected visual acuity was 0.8 (+7.00D -1.50D 180º) and of 1.0 on his left eye. 

Slit-lamp biomicroscopic examination was remarkable for finding an empty capsular bag, entire and located in its original place, with anterior and posterior capsules adhered between them. No lens material was found among them, and neither in the vitreous cavity. Intraocular pressures were 14mmHg in both eyes.  The optic discs of both eyes were slightly excavated, non-pathological, 0.3, well coloured. No other remarkable findings were described, neither signs of inflammation. 

Complementary examinations were undergone: biometry, retinal nerve fibre layer optic coherence tomography (OCT), ganglion cell layer OCT, anterior segment OCT, retinography and anterior segment photographies. Images of all of them are presented.  

The patient was programmed for primary lens implantation in sulcus in his right eye, but he disappeared before making it to the operating room.

Spontaneous lens absorption is a rare phenomenon, generally associated to surgery, trauma or infectious diseases. This condition should be taken into account in aphakic patients without history of the previous described factors. Moreover, the risk of damage of the optic nerve should be assessed, considering that some authors have described an association with phacolytic glaucoma.