A rare presentation of anterior dislocation of calcified capsular bag in a spontaneously absorbed cataractous eye.

Spontaneous lens absorption and dislocation of empty capsular bag in anterior chamber is an extremely rare phenomenon. The common predisposing factors can be weak zonular structure as in pseudoexfoliative syndrome, historical trauma or spontaneous absorption of hypermature morgagnian cataract. Here we describe a unique and rare presentation of a 53 years old gentleman who presented with defective vision in right eye (RE) for past 7 months. Visual acuity in RE was finger counting close to face and 6/60 in the left eye (LE). Anterior segment examination revealed a translucent membrane with rolled up margins in the right anterior chamber, anterior lens capsule calcification and posterior capsular breach, iridodonesis, pseudoexfoliation, sluggish pupil, and aphakia along with few vitreous strands. B scan revealed cortical matter in the anterior vitreous face in RE. The patient was planned for membrane removal, pars plana vitrectomy along with scleral fixation of intraocular lens. This case highlights the extremely rare presentation of capsular bag in anterior chamber in a spontaneously absorbed cataractous eye. Copyright:

A 53-year-old male presented with defective vision in the right eye (RE) for the past 7 months. Visual acuity in RE was finger counting close to face and 6/60 in the left eye (LE). Intraocular pressure measured with noncontact tonometry was 14 mmHg in RE and 12 mmHg in LE. Anterior segment slit-lamp biomicroscopic examination revealed a triangular-shaped translucent membrane with rolled up margins suggestive of an empty capsular bag, anterior lens capsule calcification and posterior capsular breach, iridodonesis, pseudoexfoliation, sluggish pupil, and aphakia along with few vitreous strands [Figures 1–3]. LE revealed pseudoexfoliation of lens capsule with immature cataract. There was no history of trauma, surgical intervention in past, or any genetic or hereditary disorders in family. The patient had no features of hereditary disorders such as Marfan, homocystinuria, spherophakia, and retinitis pigmentosa. Fundoscopy revealed minimal dropped cortical matter in RE. The patient had no improvement in visual acuity with +10.00 diopter lens because the membrane obscured the visual axis. The patient was advised to undergo membrane removal and pars plana vitrectomy with scleral fixated intraocular lens.

Figure 1

Image of the right eye of the patient depicting anterior dislocation of empty capsular bag in toto in the anterior chamber

Figure 3

Slit image of the same patient depicting calcified crumpled empty triangular capsular bag with posterior capsular breach, dislocated in toto in the anterior chamber

Slit image of the patient depicting anteriorly dislocated empty capsular bag with calcified anterior lens capsule

Spontaneous absorption of cataractous lens or clear lens is very uncommon in the absence of zonular weakness or trauma. Rarely, the empty capsular bag can prolapse in anterior chamber or posterior chamber.[1] The predisposing factors can be pseudoexfoliation syndrome, trauma, spontaneous absorption of hypermature morgagnian cataract, or weak zonules secondary to hereditary or congenital syndromes.[12] It has also been described in relation to Hallermann–Streiff syndrome, Down syndrome, leptospirosis, maternal rubella, or phacolytic glaucoma.[12] The other predisposing factors that have been implicated are as follows: high myopia, pseudoexfoliation, uveitis, pars planitis, myotonic dystrophy, diabetes mellitus, elderly age group, and retinitis pigmentosa.[3] There have been very few reports of spontaneous capsular bag dislocation into the anterior chamber in phakic patients.[14] Ahmad et al. reported a case of bilateral spontaneous lens absorption and published very similar anterior segment photos.[1] Similarly, Kim et al.[5] reported a similar case 62-year-old woman with no predisposing factors. The predisposing factor in our case was pseudoexfoliation that might have predisposed to a zonular abnormality. The other possibility could be that the patient developed hypermature morgagnian cataract that got absorbed and the empty capsular bag dislocated in the anterior chamber.[5] This was supported by the fact that the cortex in the anterior vitreous face was documented on B-scan. The patient was further planned for membrane removal, pars plana vitrectomy, and scleral fixation of intraocular lens to achieve the best possible visual outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.