Multimodal Imaging Of A Spontaneously Ruptured Posterior Polar Cataract In A Young Male

Posterior polar cataracts (PPC) present a known risk of posterior capsule rupture during cataract surgery. We report the AS-OCT and Ultrasound Biomicroscopy (UBM) findings in a case presenting with sudden diminuition of vision due to spontaneous posterior capsule rupture in the presence of PPC, without any history of trauma or other external factors. This observation is crucial for risk assessment in patients to be taken up for surgery for posterior polar cataract. 

Outpatient department of a tertiary care teaching hospital in North India

A 29-year-old male presented with sudden, painless vision loss in right eye. No history of trauma or other symptoms. Visual acuity was 1.4 (Logmar) in the right eye and 0.8 in the left. Slit lamp examination revealed a vertical posterior capsular tear and cataract changes in the right eye, with lens material in the anterior vitreous. The left eye showed a type 2 posterior polar cataract. Anterior Segment Optical Coherence Tomography (AS-OCT) detected a posterior capsule defect and lens matter dislocation into anterior vitreous in the right eye; left eye confirmed type 2 posterior polar cataract. Ultrasound Biomicroscopy confirmed the posterior capsule dehiscence and posterior dislocation of lens matter in the right eye, with hyperlucent plaque on the left eye’s posterior capsule.

Gradual, progressive diminuition of vision is a hallmark of cataracts but at times it can even present with sudden loss of vision, as in our case. Given the spontaneous rupture of PPC, surgical planning must include consideration for potential complications. Imaging supported a diagnosis of progressive PPC, indicating a heightened risk of rupture in the left eye. This case underscores the need for cautious management of PPC due to the risk of preoperative capsule rupture.