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Long-standing mature cataract
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 White cataract with a wrinkled anterior capsule |
A patient presents to you with a unilateral mature white cataract, and before booking her surgery, you have a hunch that something isn't quite right ...
This 60-year-old woman has a complaint of poor vision out of the left eye for 40 years. She recalls some unspecified trauma at the age of 20, then slowly losing vision in the left eye. Today is the first time that she's seeking treatment. She has an otherwise normal ocular and medical history. She does remember having normal visual function in both eyes during childhood and until the trauma.
Exam shows a normal right eye with trace nuclear cataract and 20/20 vision. The left eye has sensory exotropia of 30 prism diopters, a mature cataract and no view of the posterior segment. There is no afferent pupillary defect, and the patient is able to see light perception with projection to four quadrants. The B-scan ultrasound shows a normal posterior segment.
With the sensory exotropia, the patient understands that she'll likely have diplopia after cataract surgery and that she may need strabismus surgery in the future. So you go ahead and book her for a cataract surgery: trypan blue dye to stain the capsule, then phaco, followed by an IOL implant. Then you take one last look through the slit lamp (See figure), and you notice something odd. The anterior lens capsule appears to be wrinkled and bumpy, not smooth. What's going on? (Answer in next week's blog entry.)