An Unusual Case Of Bilateral "Spoke" Like Cataract Mimicking As Congenital Lamellar Cataract: A Rare Presentation

To demonstrate a case of bilateral "Spoke" like cataract in a 52 years old man mimicking the appearance of congenital zonular cataract. A Central nuclear opacification of the crystalline lens reminiscent of lamellar cataract was subsequently observed in the Both the eyes. A Bilaterally Symmetrical wedge-shaped opacifications in the inner cortex of the lens was seen, which radiated towards the lens equator giving appearance of “Spoke” like cataract. 

All India Institute Of Medical Sciences (AIIMS), Nagpur, India

We report the case of a 52 year old male, with no particular previous history, presenting with bilateral progressive diminution of vision since last six months. On examination the visual Acuity was 6/12 in Right eye and 6/36 in Left eye. There was no history of trauma, systemic illness or any long term drug use. Slit lamp evaluation revealed Bilaterally symmetrical central nuclear opacity, and wedge like haze of inner and outer cortex radiating towards the lens equator giving the appearance of “Spoke” like pattern. Projection from outer edge along with clear zone of cortex gave the appearance of riders as present in zonular cataract. Though the morphology was near similar with congenital zonular cataract but there was no history of congenital cataract in forefathers, or in the next sibling after them. No history of consanguineous marriage & no history of congenital cataract in the family was noted. On the other hand, the lab work didn't reveal any significant abnormality. To our knowledge this can new variety of exaggerated form of cuneiform cataract that leads to the diagnostic dilemma. A possibility of stress associated with accomodation forces inside presbyopic lenses might damage fibers, and can be responsible for spoke shaped cataract which is aslo noted in some literature. Phacoemulsification surgery with Intraocular lens Implantation was done in Left eye, after which patient achieved his full vision (6/6).

In conclusion, the current finding suggest that it is a new variety of exaggerated form of “Spoke” like cortical cataract that lead to the diagnostic dilema. However a thorough slit lamp evaluation along lab investigation is required in such cases. Further detailed family history along with evaluation of family members confirmed our diagnosis, and completel visual recovery was also seen after cataract surgery.

FINANCIAL DISCLOSURE: NONE