Multiple white dots on posterior capsule.

A 38 years old female patient presented with unilateral cataract without known predisposing factors. During cataract extraction, the surgeon noticed multiple white dots scattered over inner surface of the posterior capsule. These dots were of uniform size and shape. They were distributed uniformly and involved all the areas of the posterior capsule and extended up to equator. The surgeon decided to implant IOL and tackle the opacities in a later setup. In spite of the extensive opacities, the patient's Uncorrected Corrected Visual Acuity (UCVA) at six weeks was 6/9, Best Corrected Visual Acuity(BCVA) was 6/6 and near vision with correction was N6. The other eye was normal. This case is reported for the peculiar appearance and distribution of the capsular opacities and good visual outcome in spite of this.

Introduction

In case of mature and hyper mature cataracts, it is common to find a plaque on the posterior capsule after removal of the cataract.[1] Usually, this is a single opacity of variable size and density. In this report, author is presenting a case of mature cataract having multiple well-defined opacities on posterior capsule observed intraoperatively.

Case Report

A female patient of 38 years age presented to our outpatient department with a history of decreased vision of 9 months duration in the right eye. She had visual acuity of hand movements with accurate projection of rays in the right eye and 6/6 vision in the left eye. Lens in the right eye had mature cataract while was clear in the left eye and anterior segment otherwise was normal. Rest of history, examination, and laboratory studies were normal. The patient underwent manual small incision cataract surgery with polymethyl methacrylate intraocular lens (IOL) implantation under local anesthesia. During surgery, after extraction of nucleus and removal of cortex, the surgeon noticed multiple white dots on the posterior capsule extending up to equator [Figure 1]. These could not be removed by polishing the capsule but gave a “gritty sensation” suggestive of calcification. The dots were of uniform color, size, and distribution was also uniform. The surgeon had encountered this entity for the first time in his experience. The IOL was implanted in sulcus with appropriate adjustment of IOL power. Nd-YAG capsulotomy was planner for later to remove central dot opacities if necessary. Postoperatively, the patient was started on ciprofloxacin + dexamethasone eye drops hourly which were tapered over the next 4 weeks and stopped. At 6 weeks, the patient had an unaided vision of 6/9 and with correction of −0.75D cylinder at 90° 6/6 and N6 at near with +2.50D sphere.

Figure 1

Notice the uniform size and distribution of multiple white dots. The intraocular lens is implanted in sulcus

Discussion

Opacification of posterior capsule or preexisting “posterior capsular plaque” after cataract surgery has been described by various authors.[234] Typically, this appears as a diffuse plaque. The incidence of these plaques varies from 10% to 38% depending on the type of cataract and age.[24] It has been noted by the previous authors that the possibility of opacification is higher in mature and hypermature cataracts.[3] Vasavada et al. have noted that most of these opacities are peripheral and hence do not interfere with vision. If central, opacities are most of the times in the form of a single, diffuse plaque. Although there were multiple opacities in this case, they were exclusively confined to posterior capsule and did not interfere with vision or fundal glow [Figure 2]. These opacities appeared to be part of the capsule itself and could not be polished off the capsule. The dots neither increased nor reduced in size and thickness during the follow-up period. It was interesting that the distribution of dots was strikingly similar to that of retinal white dot syndromes. This can be a chance occurrence, or probably there may be a biochemical process affecting the capsule in a diffuse manner. The author later realized that anterior capsule could have been sent for confirmation of calcification as suggested by Chen et al.[5]

Figure 2

Good glow on retroillumination indicating minimal effect on light entry by the opacities. This also is confirmed by the unaided visual acuity of 6/9

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Conflicts of interest

There are no conflicts of interest.