Spontaneous rupture of the lens capsule in hypermature cataract: presentations and outcomes

Spontaneous Dislocation of the Lens Nucleus Into the Anterior Chamber Observed in a Patient With Overmature Senile Cataract

Overmature cataract refers to the advanced stage of cataract where timely surgical intervention is not performed, leading to further progression characterized by decreased water content in the lens, degradation of fibers, and liquefaction within its structure, which can cause a reduction in volume, wrinkling of the capsule, as well as calcification or cholesterol crystallization on its surface. In addition, it may result in deepening of the anterior chamber. If left promptly untreated, these complications may result in visual impairment or even blindness. The occurrence of spontaneous complete dislocation of the lens nucleus into the anterior chamber in overmature cataracts is extremely uncommon. The authors present a case study involving a 74-year-old female patient who was diagnosed with complete dislocation of the lens nucleus in an overmature senile cataract without any apparent ocular injury or any relevant medical records. After undergoing cataract removal combined with anterior vitrectomy, the patient experienced relief from eye discomfort and expressed satisfaction with the surgical outcome; however, her visual acuity did not show significant improvement.

Ultrasound biomicroscopy in the management of complex cataract and intraocular lens: A review

Ultrasound biomicroscopy (UBM) is an invaluable investigation for imaging anterior segment structures. Although it is operator-dependent and time consuming, unlike optical-based imaging techniques, it is able to image structures posterior to the iris, such as the zonules, ciliary body and part of the pars plana. It is especially useful in advanced cataracts, traumatic cataracts, subluxed lenses, posterior polar cataracts, and congenital and developmental anomalies affecting the anterior segment. It provides diagnostic information in eyes with complex cataracts or intraocular lens (IOL)-related pathology, and aids in surgical planning in order to minimise complications. In this review, we describe the UBM features of various lenticular pathologies and demonstrate its application in the diagnosis and surgical management of lens and IOL-related pathologies.

Prevalence and outcome of lens capsule disruption IN routine canine cataract surgery: A retrospective study of 520 eyes (2012-2019)

OBJECTIVE

To investigate the prevalence and surgical outcome of lens capsule disruption (LCD) in dogs undergoing cataract removal.

ANIMALS STUDIED

Medical records of 924 eyes undergoing phacoemulsification were analyzed retrospectively.

PROCEDURES

Routine cataract surgeries with or without LCD were included. Any LCD other than routine anterior capsulorhexis was defined as LCD and classified according to location and etiology. Odds ratios (OR) were calculated for maintaining vision, implantation of an artificial intraocular lens (IOL), and enucleation.

RESULTS

In total, 520 eyes were included. A LCD occurred in 145 eyes (27.8%; 145/520) and affected the posterior (85.5%; 124/145), anterior (6.2%; 9/145), and equatorial lens capsule (4.8%; 7/145) and at multiple locations (3.4%; 5/145). The etiology of the LCD was spontaneous preoperative in 41 eyes (28.3%; 41/145), accidental intraoperative in 57 eyes (39.3%; 57/145), and planned in 47 eyes (32.4%; 47/145). Disruption did not increase the odds of enucleation (OR = 1.48, 95% confidence interval [CI] 0.56-3.67; p = .36). The presence of LCD significantly increased the risk of losing vision 1 year post-operatively (OR = 8.17, 95% CI 1.41-84.93; p = .007) associated with retinal detachment. However, this was not present at 2 years follow-up or in PCCC cases at any time point. An IOL was implanted in 108 eyes (108/145; 75.2%) with LCD and in 45/47 (95.7%) eyes with a PCCC.

CONCLUSION

Increased surgeon awareness of possible intraoperative, accidental LCDs is important, as LCDs were relatively common and associated with increased odds for vision loss after 1 year in the present study. A prospective study investigating the causes of intraoperative, accidental LCD is warranted.

Lens nucleus dislocation in hypermature cataract: Case report and literature review

INTRODUCTION

Hypermature cataract is a form of late-stage cataract progression that can lead to a variety of complications. Spontaneous capsular rupture with lens nucleus displacement in hypermature cataracts has rarely been reported. We describe 2 cases of spontaneous dislocation of the lens nucleus in a hypermature cataract and perform a review of the literature on this complication.

PATIENT CONCERNS

We report 2 rural men aged 50 and 76 years with deteriorating vision.

DIAGNOSIS

The final diagnosis was senile hypermature cataract with dislocation of the lens nucleus in both patients and secondary glaucoma for the second patient.

INTERVENTIONS AND OUTCOMES

During admission, both patients complained of deteriorating vision. Slit-lamp examination showed lens nucleus dislocation into the anterior chamber. The 50-year-old patient exhibited a residual lens capsule and a turbid cortex, with a normal anterior chamber and intraocular pressure. The 76-year-old patient presented a shrunken and ruptured capsule and no cortex in the pupillary area, mild inflammation in the anterior chamber, and high intraocular pressure. Both patients underwent intracapsular cataract extraction combined with anterior vitrectomy and achieved good postoperative recovery.

CONCLUSION

Lens nucleus dislocation in hypermature cataracts can be seen in clinical practice, particularly in underdeveloped areas. Early recognition and surgery can improve vision.

Assessment of image quality on color fundus retinal images using the automatic retinal image analysis

Image quality assessment is essential for retinopathy detection on color fundus retinal image. However, most studies focused on the classification of good and poor quality without considering the different types of poor quality. This study developed an automatic retinal image analysis (ARIA) method, incorporating transfer net ResNet50 deep network with the automatic features generation approach to automatically assess image quality, and distinguish eye-abnormality-associated-poor-quality from artefact-associated-poor-quality on color fundus retinal images. A total of 2434 retinal images, including 1439 good quality and 995 poor quality (483 eye-abnormality-associated-poor-quality and 512 artefact-associated-poor-quality), were used for training, testing, and 10-ford cross-validation. We also analyzed the external validation with the clinical diagnosis of eye abnormality as the reference standard to evaluate the performance of the method. The sensitivity, specificity, and accuracy for testing good quality against poor quality were 98.0%, 99.1%, and 98.6%, and for differentiating between eye-abnormality-associated-poor-quality and artefact-associated-poor-quality were 92.2%, 93.8%, and 93.0%, respectively. In external validation, our method achieved an area under the ROC curve of 0.997 for the overall quality classification and 0.915 for the classification of two types of poor quality. The proposed approach, ARIA, showed good performance in testing, 10-fold cross validation and external validation. This study provides a novel angle for image quality screening based on the different poor quality types and corresponding dealing methods. It suggested that the ARIA can be used as a screening tool in the preliminary stage of retinopathy grading by telemedicine or artificial intelligence analysis.

Late spontaneous posterior capsule rupture after hydrophilic intraocular lens implantation

PURPOSE

To describe and discuss the presentation and management of 4 cases of late (17 to 20 years) postoperative spontaneous posterior capsule rupture (PCR) and intraocular lens (IOL) subluxation in eyes implanted with the same hydrophilic 1-piece IOL.

SETTING

Center for Applied Eye Research, Meir Medical Center and the Ein-Tal Eye Center, Israel.

DESIGN

Case series.

METHODS

Four patients presented with spontaneous rupture and posterior dislocation of the same design IOL (B-Lens) 17 to 20 years after implantation. No trauma or any other direct causative factor was identified in any of the cases.

RESULTS

Of the 4 cases reported, the IOLs were successfully repositioned to the ciliary sulcus and sutured to the scleral wall (1 case) or the iris (2 cases), and the IOL was stable in the sulcus without the need for further sutured fixation in 1 case, with effective vision restored in all cases.

CONCLUSIONS

Spontaneous PCR is a rare postoperative complication and has not been reported, to the authors' knowledge, in cases without predisposing factors. A mechanism of late capsular tear was not confirmed, but the specific design of the IOL might have been a contributing factor.

Corneal decompensation due to spontaneous absorption of lens and anterior dislocation of lens capsule: A case report

RATIONALE

Spontaneous absorption of lenses or cataracts is rare. However, lens capsule attachment to the endothelium combined with corneal decompensation can still occur.

PATIENT CONCERNS

An 81-year-old male presented with left eye pain and bulbar conjunctival injection for 6 months. Diffuse corneal edema and inferior bullous lesions were observed by slit-lamp microscopy. Following examination with swept-source optical coherence tomography, we could clearly identify a membrane structure adherent to the corneal endothelium, as well as a lens not in situ. In vivo confocal microscopy found decreased corneal endothelial density of 745 ± 46 cells per mm in the left eye.

DIAGNOSIS

Lens dislocation and spontaneous absorption, combined with corneal decompensation were diagnosed.

INTERVENTIONS

Surgical removal of the membrane structure combined with anterior vitrectomy was performed.

OUTCOMES

The patient's symptoms were partly relieved. However, the corneal endothelial decompensation could not be entirely reversed. In vivo confocal microscopy verified that corneal endothelium was in situ and the density was not significantly changed in the left eye.

LESSONS

This case study reports a rare dislocation and spontaneous absorption of lens without any trauma or subsequent surgery. Moreover, it demonstrates corneal endothelial decompensation due to the lens capsule adhering to the corneal endothelium. Timely intervention is required to remove the dislocated lens and prevent complications.

Phacolytic glaucoma: A nearly forgotten entity

PURPOSE

To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract.

METHODS

Case report and literature review.

RESULTS

An 80-year-old woman presented with cloudiness and pain in the left eye for 1 day. The patient had visual acuity limited to perception of light with raised intraocular pressure of 70 mm Hg. Careful slit-lamp evaluation revealed corneal epithelial edema in superior quadrant and a deep and turbid anterior chamber. Ultrasound biomicroscopy confirmed the presence of a deep anterior chamber, a hypermature cataractous nucleus with lax capsular bag, and ruptured anterior lens capsule. The patient underwent extracapsular cataract extraction. Cytological examination of the lenticular fluid revealed the presence of lens protein-laden macrophages. Post-operatively, the patient had best-corrected visual acuity of 6/60 with advanced glaucomatous optic neuropathy.

CONCLUSION

Phacolytic glaucoma can present with a cloudy cornea and a turbid anterior chamber mimicking endophthalmitis. Careful examination and ancillary investigations including ultrasound biomicroscopy was helpful in making an accurate diagnosis.

Intraoperative management of anterior capsular tear

PURPOSE OF REVIEW

The article reviews the current literature on intraoperative techniques to properly manage anterior capsular tears during cataract surgery.

RECENT FINDINGS

Femtosecond laser-assisted cataract surgery creates a more consistent capsulorhexis than traditional capsulotomies, but can also present with new challenges. Irregularities, like microadhesions and tags, can lead to anterior tears if not properly treated. New technology, like the Zepto (Mynosys, Fremont, CA, USA) pulse precision capsulotomy, may produce a smoother edge and reduce the incidence of capsular tears. However, there are novel rescue techniques in the case that a tear-out does occur.

SUMMARY

Anterior capsular tears can occur at any stage of cataract surgery. The proper management of these tears will prevent them from extending into the posterior capsule and compromising the structural integrity of the capsular bag. This is essential for endocapsular placement of artificial lenses and for optimal visual outcomes for the patient.