Lenticular Coloboma - A Strange Entity

This case report aims to highlight the clinical appearance, characteristics and management of bilateral lenticular coloboma.

A young male of 23 years of age presented to our set up for frequent change of spectacles. On undilated evaluation it was found that he was myopic. On dilatation, however, there was a clear deficiency of lenticular zonules inferiorly in both eyes. The zonular deficiency is what causes the appearance of a lenticular coloboma. 

A thorough systemic and ocular examination was done for the patient, revealing isolated ocular findings. 

A series of investigations were done to rule out any associated dystrophies or retinal findings. Biometry with IOL master and axial length was done to rule out any other causes of myopic astigmatism observed in the patient. After a thorough evaluation the patient was given the option of cataract surgery in his left eye with a posterior iris claw lens. The cataract surgery performed was Extra Capsular Cataract Extraction as there was a deficiency of zonules inferiorly for around 6 clock hours. After uneventful surgery and placement of the posterior iris claw lens, the patient has total visual recovery.

The patient recovered good vision (BCVA log 0 in Log MAR) in his left eye following ECCE with iris claw insertion. ECCE sutures caused astigmatism corrected by post-operative refraction testing and spectacle wear 4 weeks after surgery.

Visual recovery in this patient of lenticular coloboma following ECCE with Iris claw lens insertion was a good option, however amblyopia must always be ruled out and explained accordingly to the patient preoperatively.