|Year : 2023 | Volume
| Issue : 1 | Page : 190-191
Reverse nucleus drop: A bizarre phenomenon
Amrita Joshi1, Sanjay K Mishra2, Alok Sati3, Sonali V Kumar1
1 Department of Ophthalmology, Army Hospital (Research and Referral), New Delhi, India
2 Vitreo Retina Services, Army Hospital (Research and Referral); Department of Ophthalmology, Army Hospital (Research and Referral), New Delhi, India
3 Cornea and Anterior Segment Services, Army Hospital (Research and Referral); Department of Ophthalmology, Army Hospital (Research and Referral), New Delhi, India
|Date of Submission||17-Dec-2021|
|Date of Acceptance||31-Oct-2022|
|Date of Web Publication||20-Jan-2023|
Professor and Senior Advisor, Cornea and Anterior Segment Services, Department of Ophthalmology, Army Hospital (Research and Referral), New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
Keywords: Bandage contact lens, corneal perforation, lens prolapse
|How to cite this article:|
Joshi A, Mishra SK, Sati A, Kumar SV. Reverse nucleus drop: A bizarre phenomenon. Indian J Ophthalmol Case Rep 2023;3:190-1
A 60-year-old lady presented to our clinic with diminution of vision for three weeks. On slit-lamp examination, we noted a central corneal perforation with iris prolapse. Keratoplasty was contemplated, and during surgery we noticed the lens nucleus was lounging on the retina. Tectonic penetrating keratoplasty was done and the patient was posted for phaco-fragmentation. To our surprise, on the next postoperative day the lens nucleus was lying adherent to the corneal graft [Figure 1] and [Figure 2].
|Figure 2: Cross-section of slit-lamp image showing anterior surface of the graft (asterisk) and the nucleus apposed to the posterior surface of the graft (arrowhead)|
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In case of a posterior capsular rent the lens is expected to fall back on most occasions, whereas in this case the lens which was lying on the retina undisturbed was found apposed to the graft the very next day. We can hypothesize that some minimal amount of irrigating liquid during surgery seeped through the posterior capsular rent and hydrated the vitreous gel. This escalated the convection currents and probably contributed to the spontaneous hovering of the nucleus into the anterior chamber. This was an amused visual for us and we intend to share it with everyone.
A 70-year-old gentleman presented to our center with diminution of vision. On slit-lamp examination, we found a 7-mm corneal perforation, tissue melt covered with bandage contact lens (BCL), tissue adhesive lying adjacent to the site, and the lens nucleus seen prolapsed anteriorly supported by the BCL, as showcased in [Figure 3].
|Figure 3: Image depicting BCL (arrow) supporting the prolapsed lens nucleus (arrowhead) with tissue adhesive (asterisk) lying adjacent to the site|
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BCL helps to maintain ocular tissue integrity, and is often used in cases of perforations managed with tissue adhesives, but what amused us was the fact that it had the strength to support a lens prolapse and maintain the globe integrity exceptionally well in such a large perforation.
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.
Such interesting scenarios of anterior lens prolapse are rare encounters in our clinical setting and we intend to share them with everyone.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Naik MP, Sethi H, Mehta A, Bhalla A, Saluja K. Spontaneous levitation of dropped nucleus on first post-operative day. SAGE Open Med Case Rep 2017. doi: 10.1177/2050313X17708713.
Ehrlich DP. Therapeutic contact lenses. Optometry Today (UK) 2006;46:23-30.
McDermott ML, Chandler JW. Therapeutic uses of contact lenses. Surv Ophthalmol 1989;33:381-94.
[Figure 1], [Figure 2], [Figure 3]