Spontaneous anterior lens dislocation in hypermature cataract – A rare presentation

A sixty-five-year-old female presented with complaints of diminution of vision in the right eye for the last 1 year. There was no history of ocular trauma or ocular surgery. Visual acuity of the right eye was Perception of light (PL) positive with accurate PR (projection of rays). Slit lamp examination showed a small nucleus with a capsular bag attached to the endothelium Figure 1. There were vitreous strands in the anterior chamber. There were iris pigments present on zonules and anterior capsular tags. The patient’s intraocular pressure at presentation was 18 mmHg, as noted on Goldmann applanation tonometry in both eyes. There was no evidence of pseudoexfoliation.Figure 1: Diffuse slit lamp photograph of the right eye showing the nucleus with a detached capsular bag adherent to the endotheliumClinical impression of spontaneous anterior dislocation of cataractous lens adhered to the endothelium was made. Fundus examination was within normal limits. Intraoperatively, the capsular bag with nucleus adhered to the endothelium was swept with iris repositor and viscoelastic substance, and then the nucleus was aspirated with 20 G vitrector, and anterior vitrectomy was performed. Retropupillary fixation of the iris claw intraocular lens (IOL) was done. Postoperative vision was 6/60, with a clear cornea and iris claw lens well enclaved Figure 2. The patient was advised for tapering dose of steroids and antibiotics postoperatively.Figure 2: Diffuse slit lamp photograph showing iris claw intraocular lens in placeThis case is unusual rare presentation of spontaneous anterior dislocation of a hypermature Morganian cataract with nucleus attached to the endothelium. The occurrence of spontaneous complete dislocation of the lens nucleus into the anterior chamber in hypermature cataracts is extremely uncommon, with only a few cases reported in the literature.1–3 Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest to declare.