Inside-out and outside-in: Tips and tricks in posterior lenticonus

Background: Posterior lenticonus is a congenital condition characterized by the thinning and bowing of posterior lenticular capsule. Cataract develops when normal intra?lenticular pressure bulges the posterior capsule at the circumscribed portion of inherent thin posterior lens capsule, leading to derangement of lamellar lens fibers. This condition poses a surgical challenge as the presentation varies from thin, bulging posterior capsule to large, pre?existing posterior capsular dehiscence. Purpose: This video highlights the tips for the surgical management of various scenarios of posterior lenticonus. Synopsis: In this video, tips for surgical management of various scenarios of posterior lenticonus are illustrated. Intraoperatively, ruptured posterior capsule is suspected by the presence of a fish?tail sign. The anterior capsulotomy is relatively easier in a flatter anterior lens capsule, owing to reduced intra?lenticular pressure. Hydro?dissection is avoided to prevent extension of pre?existing posterior capsular dehiscence or creation of rupture in a thinned?out capsule. The peripheral lens cortex aspiration is initiated first, followed by in each quadrant. In a presence of ruptured posterior capsule by vigilant inspection at this stage, the surgeon should change the direction of lens matter aspiration by aspirating the central lenticular matter first, followed by peripheral cortex like “inside?out”. In absence of posterior capsule dehiscence, peripheral cortex is aspirated first, followed by central lens matter aspiration like “outside?in”. Adequate anterior vitrectomy is performed until there are no vitreous tags. Highlights: In the presence of pre?existing posterior capsular defect, the lens matter is aspirated from the center (inside?out), whereas in the absence of capsular defect, the lens matter is aspirated from the periphery (outside?in).

Posterior lenticonus with persistent fetal vasculature

A 10 year old girl present with both eyes central cataract with posterior lenticonus. Intraoperative, she was noted to have both eyes persistent fetal vasculature (PFV). To the best of our knowledge, association of bilateral posterior lenticonus and PFV has not been reported before. This supports the hypothesis that PFV has a role in pathogenesis of posterior lenticonus.

Multiple congenital ocular defects in a Bedlington terrier dog / 대한수의학회지

To report multiple congenital ocular defects in a Bedlington terrier dog aged 2.5 months with blindness. Routine ophthalmic examinations were performed for the clinical signs. Menace responses and cotton ball test were absent in both eyes (OU), but pupillary light reflexes were normal in OU. Slit lamp biomicroscopy reveled corneal dystrophy, posterior subcapsular cataract, microphthalmia in OU and lenticular coloboma in the right eye. In indirect ophthalmoscopy and ultrasonography, retinal detachment and posterior lenticonus were shown in OU. It is the first report of lenticular coloboma and posterior lenticonus in a Bedlington terrier dog.

Alport syndrome

Objective@#To present a case of Alport syndrome, its pathogenesis, etiology, clinical manifestation, diagnosis, and management.@*Methods@#This is a case report.@*Results@#A 22-year-old male presented with blurring of vision associated with bilateral anterior and posterior lenticonus. The patient had a history of blurring of vision on both eyes, occasional right lower-quadrant pain on urination, frothy urine, and bilateral hearing loss. Family medical history showed one brother who died at 15 years of heart disease, and another brother at 17 from chronic kidney disease. Slitlamp examination showed a conspicuous oil droplet reflex seen through retroillumination. Anterior and posterior bulging of the lens was noted, highly suggestive of anterior and posterior lenticonus. On indirect ophthalmoscopy, no perimacular dot-and-fleck retinopathy was seen. Further systemic workup revealed elevated serum levels of blood urea nitrogen (BUN) and creatinine, and marked proteinuria and hematuria. Ultrasound of the kidneys revealed bilateral renal parenchymal disease. Pure tone audiometry confirmed bilateral moderate sensorineural hearing loss. @*Conclusions@#There should be a high index of suspicion for Alport syndrome in any patient presenting with anterior and posterior lenticonus. A thorough history-taking and physical examination, including slitlamp examination through a dilated pupil, are necessary to fully support its diagnosis. There is no specifically defined treatment for Alport’s syndrome; management should be individualized and approached in a multidisciplinary fashion. Lenticonus can be treated by phacoemulsification with careful capsulorrhexis.

The Surgical Management of Posterior Lenticonus Associated with Pediatric Cataract

PURPOSE: To evaluate clinical characteristics of posterior lenticonus associated with pediatric cataracts and to identify the factors associated with final visual acuities after cataract surgery. METHODS: Thirty-eight patients (46 eyes) who were diagnosed with posterior lenticonus preoperatively or during the operation were involved in this study. We investigated the age at diagnosis, the severity of lens opacity, the pre- and postoperative best corrected visual acuity, and the effectiveness of amblyopia treatment. RESULTS: The mean age at presentation was 39.0+/-37.4 months, and the mean follow-up period was 42.8+/-33.5 months postoperatively. Nine patients (23%) had bilateral posterior lenticonus, and the mean age of bilateral cases was lower (p<0.001) and the lens opacity more severe than those of unilateral cases (P=0.001). Fifteen eyes (32.6%) were surgically identified as having posterior lenticonus during lens aspiration, the mean age of surgically identified cases was lower (p<0.001) and the lens opacity more severe then those of preoperatively diagnosed cases (P=0.014). The age at initial examination was negatively correlated with final visual acuities in log MAR (P=0.04). CONCLUSIONS: Bilateral and surgically identified posterior lenticoni were associated with younger age and more severe lens opacity. The final visual acuities were better in patients with late onsets of lens opacities.