THE POST VITRECTOMY PEACOCK FEATHER-LIKE DESICCATION CATARACT

To evaluate the clinical aspects of cataract development after vitrectomy, its change of course over time and the visual outcome of patients needing post vitrectomy cataract surgery. Gas induced cataract is a commonly seen complication of posterior segment surgery. Pneumatic retinopexy using gaseous sulfur hexafluoride disrupts the lens transparency and promotes cataract formation. It is usually temporary, reversible, and disappears after the gas is absorbed and replaced with aqueous humor, but it can stay permanent.

Specialty hospital in Rabat, Morocco, the department of Ophtalmology A

We report the story of a patient, S.H, aged 51 years old, without medical or surgical history, presented with a sudden vision loss of the left eye two days before her admission.

The visual acuity was evaluated at hand motion(HM) in left eye and 7/10 with correction in right eye, the examination of the anterior segment was normal apart from an incipient subcapsular cataract. The posterior segment demonstrated a superior bullous detachment with giant tear on the left, and palisades on the right. The patient underwent emergency surgery, with a pars plana vitrectomy and a gas tamponade with sulfur hexachloride, and was seen again on the next day, the anterior segment showed no significant abnormalities apart from a conjunctival hyperemia, and the posterior segment was inaccessible due the gas.
On the weekly check-up, upon examination of the patient, the posterior segment revealed an attached retina with gas-filled eye. In addition, we observed a new-onset posterior subcapsular cataract, which had a typical ferning pattern. 
On subsequent follow-up appointments over 10 days, we reported that despite the absorption of the gas, the cataract remained. The patient had to undergo a follow-up cataract surgery with intraocular lens implantation.

Peacock feather-like desiccation cataract, is a sub capsular cataract commonly seen 24 hours after surgical intervention using pneumatic retinopexy used to treat retinal detachment, it is due to the contact between the gas used for the tamponade and the posterior capsule of the lens, and is caused by the oxidative stress of the lens. It is called evanescent cataract because it is temporary, reversible, and usually disappears after the gas is absorbed and replaced with aqueous humor, but it can stay permanent due to long acting gases, the amount of gas used and the position of the bubble.