Aphakic Amblyopic Eye Presented By Opaque White Ring Dislocated To The Anterior Chamber After Blunt Trauma: A Case Report Of Soemmering’S Ring

Presentation of a case of dislocated Soemmering ring in the pupillary area after trivial trauma.

Case presented at outpatient clinic of Alexandria Ophthalmology Hospital and the operation performed under general anaethesia at the operating room, Alexandria ophthalmology hospital.

A 65-year-old male working as plumber presented with a sudden appearance of large white foreign body in his left eye after blunt trauma. The patient underwent cataract surgery without IOL implantation 53 years ago for taumatic cataract. Clinical examination showed VA of hand movement, exotropia, conjunctival hyperemia, mild corneal haze and edema, AC occupied by semilunar shaped solid white foreign body. Pupil was upward peaked by the foreign body and IOP was 32 mmHg. Retina could not be assessed clinically. Combined A and B-Scan ultrasound of the posterior segment was unremarkable with 32mm axial length. VEP showed reduction in the amplitude of pattern-reversal VEP with significantly prolonged latency period.Surgical extraction under general anesthesia was performed. The foreign material was hard in consistency, white in color, semilunar measuring 7 mm long and 2.5 mm in diameter. The shape of the material was unusual for soemmering ring and was not attached to zonules. Lesion was sent for histo-pathological examination. Microscopic examination revealed a disc of amorphous structureless material of lens cortical fibers with evident edema. On day 7, the wound was clean coapted, visual acuity was counting fingers at 50 centimeters, corneal oedema began to resolve and the IOP was 21 mm Hg. On day 42, the wound was clean, cornea clear, AC formed, pupil semidilated oval reactive and IOP was 16 mmHg and sutures were removed. Visual acuity improved to counting fingers at one meter.

patients who underwent cataract surgery with old-fashioned techniques without polishing of epithelial cells underneath the anterior lens capsule have an increased possibility to develop unusual complications such as Soemmering ring which is a kind of after cataract. High myopia increase the risk of ring dislocation either spontaneously or post truma. We can intervene in some cases just for cosmetic purposes  with the understanding of no visual potential or insignificant improvment which confirmed in this case clinically by exotropia and objectively through specific pattern-reversal VEP, However good patient counseling is crucial in such situations.biopsy is mandatory to confirm the histopathological  background of the extracted mass.