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Letter

Posttraumatic Neovascularization in a Cataractous Crystalline Lens

Hwang, Yih-Shiou MD; Lai, Chi-Chun MD

Journal of Cataract & Refractive Surgery: May 2003 - Volume 29 - Issue 5 - p 860-861
doi: 10.1016/S0886-3350(03)00311-0
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Reply:

The authors document an interesting case of intralenticular hemorrhage in a 10-year-old child. They suggest the hemorrhage may be due to trauma or a developmental anomaly. They did not find vessels in the lens but only a thickened and intact capsule behind the blood clot. The theory of congenital anomaly of the hyaloid artery was logical in a 10-year-old child. However, according to the picture and findings during the surgery, we conjecture that trauma was most likely. If any neovascularization or residual hyaloidal vessels existed and caused a blood clot, there should have been traces in the capsule or vitreous cavity. It is reasonable to have a thickened and intact capsule after trauma. The lens epithelial cells could repair the crack in the capsule after trauma.

Our case did not have an intralenticular blood clot but intralenticular neovascularization. We think there is a dynamic balance between inhibition and stimulation of angiogenesis in ocular tissues such as the cornea and lens. If the ocular tissue loses this balance because of trauma or inflammation, it will sometimes induce neovascularization. It happens more frequently in the cornea than in the lens. The relationship between the trauma history and the neovascularization in a cataractous crystalline lens is a logical inference in our case. The neovascularization in the crystalline lens was rare, even in the case of extensive neovascularization such as ocular ischemic syndrome, proliferative diabetic retinopathy, and old central retinal vein occlusion. In our case, the intralenticular neovascularization was the result of many factors such as a ruptured capsule, long-term inflammation, and adhesion of the iris to the ruptured capsule. The iris may allow the vascular endothelium to grow into the damaged lens and form intralenticular neovascularization.

Yih-Shiou Hwang MD

Chi-Chun Lai MD

© 2003 by Lippincott Williams & Wilkins, Inc.