Bilateral asymmetrical isolated lens coloboma with persistent pupillary membrane
A 12-year-old girl presented with a bilateral decrease in vision. The best corrected visual acuity (BCVA) was 6/60 in both eyes with −10.0 diopter (D) correction, and the axial length was 27.59 mm. Ocular examination showed superior notching of the crystalline lens in the right eye and nasal notching in the left eye (Figure 1). In both eyes, the anterior capsule showed pigmentation simulating sago grain (Figure 2).There was bilateral posterior subcapsular cataract but no anisocoria, corectopia, or iris or ciliary coloboma. No associated retinochoroidal coloboma was seen (Figure 3). There was no positive family history or evidence of any systemic disease. Preoperatively, the refraction was −11.0 −3.50 × 125 in the right eye and −10.0 −3.50 × 90 in the left eye.
Phacoemulsification and posterior chamber intraocular lens (IOL) implantation were performed in both eyes with the aid of a capsular tension ring (CTR). The surgery was accomplished using 4 iris hooks beneath the anterior capsule margin to stabilize the capsule (Figure 4). A CTR with a 12.0 mm diameter was inserted into the capsular bag, followed by phacoaspiration and IOL implantation in the bag. The iris hooks were removed at the end of surgery. Postoperatively, the refraction was +2.25 −4.0D × 180 in the right eye and +1.75 −3.25 × 160 in the left eye and the BCVA was 20/200 in both eyes. The patient was amblyopic but did not have any tropia. Electron microscopy of the anterior capsule was consistent with the diagnosis of persistent pupillary membrane on the lens capsule (Figure 5).
Coloboma of the lens is usually unilateral.1 It is typically located inferiorly, and if bilateral, is symmetrical.1,2 Our patient had asymmetrical lens colobomas, highlighting a rare presentation.
1. Aggarwal A, El-Bash A-R, Inker S, Musarella MA. Symmetrical bilateral lens colobomas in two brothers. J Pediatr Ophthalmol Strabismus. 2004;41:302-304.
© 2007 by Lippincott Williams & Wilkins, Inc.
2. Angra SK, Gupta S, Dada VK, Gupta AK. Coloboma of the lens. Indian J Ophthalmol. 1984;32:21-22.