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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 2
| Issue : 3 | Page : 806-807 |
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Oil droplet appearance of posterior lenticonus mimicking subluxation of lens
R Neena1, M Vikraman2
1 Department of Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Giridhar Eye Institute, Kochi, Kerala, India
2 Department of Ophthalmology, Giridhar Eye Institute, Kochi, Kerala, India
| Date of Submission | 15-Apr-2022 |
| Date of Acceptance | 13-May-2022 |
| Date of Web Publication | 16-Jul-2022 |
Correspondence Address:
Dr. R Neena
Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Giridhar Eye Institute, Kadavanthara, Kochi, Kerala - 682 020
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_933_22
Keywords: Oil droplet, posterior lenticonus
How to cite this article:
Neena R, Vikraman M. Oil droplet appearance of posterior lenticonus mimicking subluxation of lens. Indian J Ophthalmol Case Rep 2022;2:806-7 |
A 2-year-old male child was brought with complaints of intermittent inward squinting since birth. On examination the child was fixing and following light with both eyes, but fixation was unmaintained in the right eye (RE) with an intermittent right convergent squint. Cycloplegic refraction was + 3.50 DS both eyes with retinoscopy showing an irregular reflex with a central opacity RE. Dilated examination RE showed deep anterior chamber (AC) with a central globular reflex resembling an oil droplet suspicious of subluxated lens [Figure 1]. Left eye (LE) appeared normal. Ultrasound (USG) B-scan RE showed a conical protrusion of the posterior lens capsule [Figure 2]. Possiblity of posterior lenticonus was considered, a complete paediatric evaluation was done; however, no associated systemic conditions were found. The patient was taken up for examination under anaesthesia with the possible need for cataract surgery explained to parents. Under the operating microscope, the oil-droplet sign was noted to be early posterior lenticonus with posterior subcapsular lens opacity [Figure 1]. Intraocular pressure, corneal diameter, axial length, and fundus were normal in both eyes. The patient underwent lens aspiration with reduced parameters of irrigation, aspiration, and bottle height. Hydrodissection was deferred and care was taken to avoid shallowing of AC at all stages of surgery. After aspiration of lens matter, in the area of posterior lenticonus, posterior capsular dehiscence was noted with lens epithelium covering the dehiscent area [Figure 3] and the same was removed using vitrector. After anterior vitrectomy, a three-piece foldable posterior chamber intraocular lens was implanted into sulcus and optic capture done [Figure 4]. Postoperatively, the patient did well, was prescribed glasses, and advised occlusion of LE 2 h/day. | Figure 1: Oil-droplet sign – seen intraoperatively under an operating microscope
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 | Figure 2: USG B-SCAN showing a conical protrusion of posterior lens capsule
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 | Figure 3: Posterior capsular dehiscence with lens epithelium covering the dehiscent area, noted intraoperatively
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| Discussion | |  |
Posterior lenticonus is a rare condition which is characterized by bowing of posterior lens capsule and progressive degeneration of lens fibres[1], often associated with cataract[2] and posterior capsular dehiscence.[2] Under the stress of intralenticular pressure or zonular traction, the area of posterior capsular defect exhibits progressive bowing, disorganization, and opacification of subcapsular lamellae, leading to rapid cataract formation.[1] A congenital weakness of the posterior capsule related to the presence of a persistent hyaloid artery is another mechanism postulated.[2] Mostly, it is unilateral, sporadic, and isolated. Bilateral posterior lenticonus can be associated with X-linked inherited disorders like Lowe syndrome or other metabolic syndromes.[2] Various signs in posterior lenticonus are described in [Table 1]. Our patient being a child was uncooperative for slit-lamp examination, and the “oil droplet” appearance with a deep AC gave the impression of a subluxated lens. However, an USG B scan and examination under microscope confirmed the presence of posterior lenticonus with posterior capsular dehiscence and subcapsular lens opacity, which was managed adequately.
A high index of suspicion and careful examination are necessary to distinguish congenital cataracts with posterior lenticonus. In early lenticonus, it may be mistaken for subluxation unless examined under a slit lamp or an operating microscope. Hydrodissection should be avoided in cases with posterior lenticonus as it can often be associated with posterior capsular dehiscence and inadvertent lens matter drop into vitreous cavity.[2],[3]
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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Amaya L, Taylor D, Russell-Eggitt I, Nischal KK, Lengyel D. The morphology and natural history of childhood cataracts. Surv Ophthalmol 2003;48:125-44.  |
| 2. | Wilson ME, Trivedi RH. Intraocular lens implantation in pediatric eyes with posterior lentiglobus. Trans Am Ophthalmol Soc 2006;104:176-82. |
| 3. | Vasavada AR, Praveen MR, Nath V, Dave K. Diagnosis and management of congenital cataract with preexisting posterior capsule defect. J Cataract Refract Surg 2004;30:403-8 |
| 4. | Ranjan P, Mishra D, Bhadauria M. Atoll sign in posterior lenticonus: A case report of bilateral posterior lenticonus with review of literature. J Clin Ophthalmol Res 2014;2:152. [Full text] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1]
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