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Consultation section

Cataract surgical problem

June consultation # 1

Masket, Samuel MD

Journal of Cataract & Refractive Surgery: June 2008 - Volume 34 - Issue 6 - p 883
doi: 10.1016/j.jcrs.2008.04.004
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A healthy 89-year-old woman reports gradual, progressive, painless bilateral diminution in vision. She has no history of ocular disease and is not being treated for any systemic disorder. She denies ocular trauma.

The ocular examination shows a best corrected visual acuity of 20/60 in both eyes with a modest myopic refractive error. The intraocular pressure (IOP) is recorded at 12 mm Hg bilaterally, and both eyes have advanced nuclear cataract. The posterior segment examination is fully normal bilaterally, and a retinal acuity meter evaluation yields a potential acuity of 20/20 for each eye.

Anterior segment examination of the left eye shows only a nuclear cataract. However, examination of the right eye shows a thin, colorless, diaphanous membrane within the pupillary space; in addition, a dense nuclear cataract is noted (Figure 1).

Figure 1
Figure 1:
Slitlamp photomicrograph of the right eye shows a thin, diaphanous papillary membrane that seemingly emanates from the anterior surface of the lens. A nuclear cataract is also noted.

At cataract surgery, the thin membrane seems to be attached to the anterior lens surface (Figure 2). Moreover, the membrane moves when intracameral anesthetic agent is instilled (Symbol Video 1).

Figure 2
Figure 2:
Intraoperative microscopic view of the right eye. No incision has been made. Note a disturbance of the anterior capsule centrally.

Given this unusual finding, how would you proceed with the surgery?


Supplementary data associated with this article can be found in the online version, at doi:10.1016/j.jcrs.2008.04.004

© 2008 by Lippincott Williams & Wilkins, Inc.