An 18-year-old female presented with glare in both eyes increasing for the past 2 years. Slit lamp examination showed temporal location of posterior polar cataract (PPC), rather than the normal central position with moth eaten appearance in periphery in right eye Fig. 1 (A – diffuse illumination, B – retroillumination), left eye implanted multifocal IOL, wherein the posterior capsular dehiscence was converted into a peripheral primary capsulotomy (C – white arrow points posterior capsulotomy margin, D – few lens deposits in anterior vitreous face AVF).Figure 1: (a) Slit lamp image showing discoid plaque with extracellular material deposit characteristic of PPC in peripheral temporal location in right eye. (b) Retroillumination of same eye showing peripheral location of PPC with significant extracellular material deposit in posterior layer. (c) Left eye showing implantation of multifocal IOL with peripheral primary capsulotomy (white arrow). (d) Same eye in diffuse illumination with few matrix material floating in anterior vitreous face(AVF)It has been thought that the PPC results from hyaloid artery persistence or mesoblastic tissue invasion of the lenticular substance. It manifests as PPC forms during early embryonic life and results in glare, photophobia, and defective vision during the third to fifth decade. An autosomal dominant (AD) pattern has been documented for PPC, but occasionally, it can be sporadic.1 A PPC consists of dysplastic lens fibers, which, in their migration posteriorly from the lens equator, exhibit progressive lens opacity, increased degenerative changes, with the formation of a characteristic discoid posterior polar plaque-like cataract and the accumulation of extracellular material, resulting in central lenticular opacity.2–5 There is extreme thinness and fragility of the posterior capsule (or perhaps even absent) with adherence of the acellular opacity to the capsule.6 The chance of having a preexisting posterior capsular defect is around 20%. The incidence of intraoperative posterior capsule rupture (PCR) in eyes with PPC has been reported to vary between 7.1% and 36%.7–9 To the best of our knowledge, this location of PPC has never been reported before, and it is likely to make the cataract surgery more challenging in these cases. Authors' contributions Dr Kalpana Narendran: Primary surgeon of the described case, final approval of the version to be published, proof reading; Dr Bala Saraswathy: Literature search, writing and preparation of the manuscript, proof reading. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Saraswathy et al. (Thu,) studied this question.