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Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 391-393

Bilateral symmetrical spontaneous anterior capsule rupture of the cataractous lens in a child

Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Date of Submission21-Jun-2021
Date of Acceptance27-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Chinmayee J Thrishulamurthy
No 5/1 Mountain Street, 2nd Cross, Jayanagar, 1st Block, Bengaluru - 560 011, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1689_21

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We report the management of a rare case of bilateral, symmetrical, and spontaneous anterior lens capsule rupture with total soft cataractous lens in a 7-year-old child. The patient had no other predisposing factors or systemic associations. Bilateral lens aspiration was done through the fibrosed capsular opening, which behaved like a stable capsulorhexis and hydrophobic intraocular lens was implanted. At 6 weeks follow-up, the patient had good visual outcome without any astigmatism. Although capsule rupture is reported in trauma, Alports syndrome or in hypermature cataracts, to our best knowledge this is the first case report of bilateral symmetrical spontaneous anterior capsule rupture in an otherwise normal child.

Keywords: Anterior capsule rupture, cataract, pediatric, spontaneous

How to cite this article:
Thrishulamurthy CJ, Saiprasad D. Bilateral symmetrical spontaneous anterior capsule rupture of the cataractous lens in a child. Indian J Ophthalmol Case Rep 2022;2:391-3

How to cite this URL:
Thrishulamurthy CJ, Saiprasad D. Bilateral symmetrical spontaneous anterior capsule rupture of the cataractous lens in a child. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 18];2:391-3. Available from: https://www.ijoreports.in/text.asp?2022/2/2/391/342895

Anterior capsular rupture of the lens can be spontaneous or following trauma. Spontaneous capsular rupture was first described by Ulrich in 1882.[1] Further spontaneous capsular rupture in hypermature cataract, steroid-induced intumescent cataract, anterior lenticonus, and Alport's syndrome have been reported.[2],[3],[4],[5] In children spontaneous rupture of lens capsule is reported in cases of Alport's syndrome.[3] We report the management of a case of a 7-year-old child with bilateral, symmetrical, and spontaneous rupture of the anterior lens capsule with total cataractous lens with no systemic associations.

  Case Report Top

A 7-year-old boy presented to a tertiary ophthalmic center in Southern India with a history of white discoloration in the black portion of both the eyes since 1e year associated with insidious onset of gradually progressive diminution of vision. There was no history of redness, pain, use of spectacles, trauma, and medications. No significant birth history, family history, and systemic history. On examination, best-corrected visual acuity (BCVA) in the right eye was perception of light and in the left eye hand movements close to face with accurate projection of rays in both the eyes. In the right eye, the anterior chamber was of irregular depth, and there were two clumps of cataractous lens matter [Figure 1]. Anterior capsule showed a rupture involving pupillary axis, extending inferiorly and was biconvex in shape with fibrosis of edges. In the left eye, similar rupture of anterior capsule was noted along with total cataractous lens [Figure 2] that was bulging into the anterior chamber making the anterior chamber depth irregularly shallow. There was no significant uveitis in both the eyes. Rest of the anterior segment examination was normal in both eyes. Intraocular pressure by applanation tonometry was 12 mmHg in both eyes. B scan ultrasonography done for posterior segment evaluation in both the eyes were normal. Systemic evaluation did not reveal Alport's syndrome or any other systemic abnormalities.
Figure 1: Right eye showing two clumps of cataractous lens material in the anterior chamber

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Figure 2: Left eye showing biconvex anterior capsule rupture

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Biometry was done and intra ocular lens (IOL) power was calculated using SRK TII formula with deduction of 10% for age according to Dahan et al.[6] Lens aspiration through the stable ruptured capsule was done, and a 22 diopter hydrophobic acrylic foldable IOL was implanted in the bag in both the eyes under general anesthesia [Figure 3] and [Figure 4]. Surgery and postoperative course were uneventful. Fundus examination was normal. Child was treated postoperatively with antibiotic-steroid eye drops in tapering dose for 6 weeks along with cycloplegic–mydriatic eye drops. At the sixth week follow-up, BCVA in both eyes were 20/30 (6/9) for distance with +1.75DS and N6 for near with +2.5D near add. Child is on a regular follow-up.
Figure 3: Right eye intraoperative photograph showing fibrosed anterior capsule edges

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Figure 4: Left eye intraoperative photograph showing stable intraocular lens placed in the capsular bag

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  Discussion Top

Anterior capsular rupture can be spontaneous, traumatic, due to intraocular tumors, suppurative inflammation, anterior lenticonus, anterior polar cataract, steroid-induced cataract, or hypermature cataract.[4],[5],[7] Spontaneous rupture in young patients is associated with syndromes such as Alport's syndrome and  Marshall syndrome More Details.[8] Spontaneous rupture in otherwise healthy young patient is rare as the capsule is more elastic and expands with increasing density of cataract.[7] Leakage of lens particles through the rupture can lead to glaucoma.

One case of bilateral spontaneous rupture of anterior capsule has been reported in 8-year-old otherwise healthy boy where the rupture and lens opacification was asymmetrical.[7] In our patient, the rupture and the density of cataract was symmetrical, and there was no systemic abnormality suggestive of Alport's syndrome or Marshall Syndrome. Possibility of isolated anterior lenticonous to be kept in mind in our case which can lead to capsular thinning and spontaneous rupture followed by increased hydration of lens and progressive opacification giving rise to soft total cataract.

The lens capsule is thicker anteriorly than posteriorly and at the equator than at the poles, being thinnest at the posterior pole. Thickness at the posterior pole and anterior pole being 2.8 and 15.5 μm, respectively.[9] The normal lens capsule is predominantly made up of type IV collagen. It also contains type I and type III collagen and other extracellular matrix components such as laminin, fibronectin heparin sulphate proteoglycan, and entactin. Every constituent is important for the biomechanical properties of the capsule.[9] Capsular fragility results from mutation of gene encoding for any of these constituents. With increasing lens fibers that are laid down, volume of the lens increases and capsule gives away at weakest point.[7] Multiple capsular dehiscence containing fibrillar material and vacuoles have been demonstrated on histopathological examination of anterior capsule in a patient with Alport's syndrome.[10]

In our case, bilateral lens aspiration and IOL implantation were planned as there were no symptoms and signs of anterior uveitis during the course of disease. Lens was aspirated through the ruptured site, and IOL was inserted through the ruptured anterior capsule and placed in the bag without the need for further capsulotomies. Fibrosed edges of ruptured anterior capsule did not pose any threat of peripheral extension or posterior capsular rent. Fibrosed edges did not cover the pupillary area; therefore, we did not try to convert it into capsulorhexis for the fear of peripheral extension and IOL instability.

  Conclusion Top

Bilateral spontaneous symmetrical rupture of the anterior capsule is rare in otherwise healthy young individuals. Detailed systemic work is to be done to rule out systemic associations. Timely management helps in achieving good visual outcome and also prevents further complication such as lens induced glaucoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names 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.

  References Top

Scott JG. Spontaneous rupture of the lens capsule. Br J Ophthalmol 1953;37:58-60.  Back to cited text no. 1
Sukhija J, Ram J, Brar GS, Bandhyopadhyaya S. Spontaneous rupture of anterior lens capsule. Indian J Ophthalmol 2006;54:216-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
Oto S, Aydin P. Rupture of the anterior lens capsule in Alport syndrome. JAAPOS Oct 2000;4:324.  Back to cited text no. 3
Hemalatha C, Norhafizah H, Shatriah I. Bilateral spontaneous rupture of anterior capsules in a middle-aged woman. Clin Ophthalmol 2012;6:1955-7.  Back to cited text no. 4
Gaviria JG, Johnson DA, Scribbick FW III, Gallardo MJ. Spontaneous anterior capsular rupture associated with anterior polar cataract. Arch Ophthalmol 2006;124:134-5.  Back to cited text no. 5
Dahan E, Drusedau M. Choice of lens and diopteric power in paediatric pseudophakia. J Cataract Refract Surg 1997;23(Suppl 1):618-62.  Back to cited text no. 6
Chaurasia S. Bilateral spontaneous rupture of the anterior capsule. J Cataract Refract Surg 2008;34:1413-5.  Back to cited text no. 7
Endo S, Hashimoto Y, Ishida N, Kusano Y, Ohkoshi K, Yamaguchi T. [A case of Marshall syndrome with secondary glaucoma due to spontaneous rupture of the lens capsule]. Nihon Ganka Gakkai Zasshi 1998;102:75-9.  Back to cited text no. 8
Bron AJ, Tripathi RC, Tripathi BJ. The Lens and Zonules in Wolff's Anatomy of the Eye and Orbit. 8th ed. Chapman and Hall; 1997. p. 411-5.  Back to cited text no. 9
Streeten BW, Robinson MR, Wallace R, Jones DB. Lens capsule abnormalities in Alport's syndrome. Arch Ophthalmol 1987; 105:1693-7.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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