Unilateral Posterior Lentiglobus: A Rare Case Report

Posterior lentiglobus is a rare disease characterized by unilateral or bilateral conical or hemispherical protrusion of the posterior lens surface with or without central posterior subcapsular lens opacity. We report a case of unilateral posterior lentiglobus that was treated by lens aspiration and intraocular lens implantation.

A case reported at tertiary eye care centre in South India

A 17-year- female presented to our hospital complaining of blurring of vision in right eye since 1 year. The girl was normal full-term delivery, breast fed. Her mother had no history of radiation exposure in her pregnant period. Best corrected visual acuity in the right eye and left eye was 20/100 p and 20/20 respectively. The patient’s manifest objective refraction was +3.50 DS in the right eye with dual dazzle reflex (myopic in centre and hyperopic in periphery respectively) and –0.50 DS in the left eye.

Slit lamp examination of the right eye was within normal limits except for hemispherical protrusion of the posterior lens surface without any  opacity in the central region of the lens in the right eye. Direct ophthalmoscopy revealed an oil droplet reflex in right eye.

We performed SL Photography to document posterior lenticonus,Oculyzer to asses any corneal changes. Scheimpflug  imaging of crystalline lens showed protusion on posterior lens capsule in right eye whereas left eye didn’t showed any lenticular bulge. Wavefront abberometry with I Tracer in right eye showed -3 D of astigmatism. Root mean square (RMS) ocular total high-order aberrations (HOAs) with a 4.5 mm diameter pupil in the right and left eyes were 7.842  and 0.628 µm respectively.  Yet, the map of corneal HOAs was homogeneous, suggesting that the ocular HOAs were originated from the lens. Patient was diagnosed as Posterior lentiglobus and underwent Lens aspiration and foldable intraocular lens implantation. 

Posterior lentiglobus commonly causes a monocular developmental cataract in the absence of microphthalmia. It may be undiagnosed early in life when the capsular bulge produces a highly myopic and somewhat distorted central lens reflex but no noticeable cataract. However, a delayed diagnosis of posterior lentiglobus may result in dense amblyopia from form vision deprivation, which may be resistant to occlusion therapy after surgery.