Interactive Case Reports

Spontaneous detachment of anterior polar pyramidal cataract

Case Report Details

First Author: L.Hamidovic UK

Co Author(s):    R. Allen   C. Dimitriou                 

Abstract Details

Purpose:

Anterior polar cataracts are congenital opacities involving the anterior capsule and subcapsular cortex. They are typically small, bilateral, symmetric, non-progressive, and not visually significant. Pyramidal cataracts are unusual conical opacities that project into the anterior chamber from the anterior capsule of the lens. In this case report we aim to highlight an interesting presentation of congenital anterior polar pyramidal cataracts and the unusual subsequent spontaneous detachment without causing any visual impairment.

Setting:

Ophthalmology Department, Colchester General Hospital, Colchester, UK

Report of Case:

We present this case of an 80-year-old woman, who was referred by her optometrist to the Hospital Eye Service in 2017 due to a suspected glaucomatous optic nerve head appearance. The referral letter reported dense left amblyopia (visual acuities were recorded as Right 0.00, Left +0.70). On her initial examination she was asymptomatic and noted to have bilateral congenital anterior polar pyramidal cataracts, left more prominent that the right. Our patient has a past medical history of hypertension. She reported no traumatic exposure to her eyes, inflammatory symptoms in the past or current changes to her vision (to confirm). At her most recent examination (August 2019-? April 2020) it was noted that the anterior polar cataract in the right eye was no longer attached to the lens capsule, but was instead located anteriorly within the anterior chamber, infero-temporally to the pupil, anterior to the iris margin. (See images: Right 1, Left 2). Her visual acuity was unchanged (visual acuity R+ 0.1, L +0.5 pinhole +0.5), intraocular pressure within acceptable limits at 10mmHg in both eyes. There was no inflammatory anterior chamber activity. Her cornea remained clear with a central corneal thickness of 528µm in the right eye and 533µm in the left. Our patent developed a nuclear sclerotic cataract left worse than the right, but has declined cataract surgery again, as she is very nervous about surgery. She denies any history of recent ocular or head trauma. She currently uses Latanoprost nocte in both eyes and is stable for the time being.

Conclusion/Take Home Message:

This case is particularly important to highlight the need for close monitoring of anterior polar cataracts and any subsequent changes to visual acuity. We believe our case is the first report of a spontaneous detachment of an anterior polar cataract, without any visually impairing effects or need for visual rehabilitation.

Financial Disclosure:

None