Unilateral Progressive High Myopia Associated With Early-Onset Nuclear Sclerosis Cataract; A Case Report

Cataract is a common cause of visual impairment and the most common cause of preventable blindness.[1]  There are nearly 180 million people with impaired vision worldwide; of them, more than 40% of cases are caused by cataract. In Saudi Arabia, approximately 20% of patients with diminished vision have cataract, which contribute to 50% of total blindness patients. Young patients with lenticular myopia and nuclear sclerotic cataracts are commonly diagnosed during preoperative evaluations for refractive surgeries. This study presents a case report of idiopathic unilateral progressive high myopia in a 42-year-old female patient with nuclear sclerosis.

Setting 

All surgical interventions were carried out in conformity with the Declaration of Helsinki and after a complete explanation of the possible benefits and risks of the surgical procedure. The patient assigned informed consent before the surgery.

A 42-year-old female patient presented with blurring of vision in her right eye. The blurring has progressively worsened over the six months before her visit and has not improved with her previously prescribed glasses, which were based on her refraction of -2.25D at our clinic four years ago. The patient had chronic allergic rhinitis, bronchial asthma, and gastroesophageal reflux disease.

 The best-corrected distance visual acuity (BCVA) was 20/120 with a refractive error of -15.25 diopters in the right eye. Ocular biometry measurements were normal, and slit-lamp examination ocular findings were unremarkable, except for discrete dense nuclear sclerosis. A diagnosis of unilateral nuclear sclerosis-induced high progressive myopia has been confirmed. The patient underwent phacoemulsification in the right eye with a monofocal intraocular lens implantation. Postoperatively, the patient achieved a BCVA of 20/20 in the right eye on the first day and reported high satisfaction with the outcome.

The present study highlighted that nuclear sclerosis could induce high-index refractive myopia in unilateral cases. Patients presenting with unexplained visual impairment and progressive myopia, even with unilateral involvement, should be examined and followed to detect early lens changes that may cause progressive high-index refractive myopia.