Bilateral Resorbed Congenital Cataract: An Intraoperative Surprise In A Patient With No Risk Factors.

To describe the clinical and therapeutic characteristics of a patient with bilateral rebsorbed congenital cataract with no known risk factors.

Cataract Department, Centro de Oftalmología Barraquer, Barcelona, Spain.

An 8-month-old female patient came to our center for a second opinion. The examination in the operating room revealed the presence of bilateral white cataract, with no other findings of interest in the anterior segment. Axial lengths obtained by ultrasonic biometry were 19.17mm in the right eye (RE) and 20.27mm in the left eye (LE). Keratometries were 44.75D in OD and 44.75D in OI. Posterior segment ultrasounds suggested clean vitreous cavity and well-applied retina in both eyes (BE). The initial diagnosis was bilateral white cataract.  

Sequential cataract surgery with intraocular lens implantation and planned posterior capsulectomy in BE was performed. 

During LE surgery, once the capsulorexhis was performed with retinal scissors, hydrodissection was performed, and an absence of crystalline lens was observed. Some isolated peripheral cortex was observed, which was aspirated with cannulas. The surgery continued without complications with a posterior slit-assisted capsulorhexis, an anterior vitrectomy and placement of a Vivinex isert XY1 +26.5D intraocular lens. The surgery presented no postoperative complications so it was decided to operate on the OD at one week.  

During the surgery of the RE the same anomaly was observed, so the final diagnosis was bilateral resorbed congenital cataract. The intraocular lens implanted in the OD was Vivinex isert XY1 +30.0D. 

Congenital cataract surgery remains a challenge for experienced surgeons due to the difficulty of clinical examination, anatomical variations and poor visual outcomes. Proper intraocular lens selection is challenging due to the continuous growth of the eye, the difficulty in obtaining reliable biometric measurements and poor reproducibility of calculation formulas.

In our patient, the presumptive diagnosis of white cataract was a resorbed cataract. This entity is associated with multiple ocular pathologies, genetic diseases or intrauterine inferctions. In our patient, none of these causes could be demonstrated. Re-interrogation of the legal guardians about any of these conditions may help us in the future management of these patients.