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PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 808-809

Tear drop in Bull's eye


Department of Cataract and IOL Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Submission21-Feb-2022
Date of Acceptance25-Mar-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Madhu Shekhar
Chief, Department of Cataract and IOL Services, Aravind Eye Hospital and Post graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_483_22

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  Abstract 


Keywords: Anterior segment optical coherence tomography, posterior polar cataract, teardrop sign, traumatic posterior capsule dehiscence


How to cite this article:
Kamble S, Rashme V, Chaudhary S, Shekhar M, Nagu K. Tear drop in Bull's eye. Indian J Ophthalmol Case Rep 2022;2:808-9

How to cite this URL:
Kamble S, Rashme V, Chaudhary S, Shekhar M, Nagu K. Tear drop in Bull's eye. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Dec 3];2:808-9. Available from: https://www.ijoreports.in/text.asp?2022/2/3/808/351195



A 27-year-old male presented with complaints of defective vision in the right eye (RE) for 6 months, associated with a history of trauma to the RE with a fist. Best-corrected visual acuity (BCVA) in the RE was 6/12 and in the left eye (LE) was 6/6. Dilated slit-lamp biomicroscopy in each eye revealed a posterior polar cataract with RE showing preexisting posterior capsular (PC) dehiscence [Figure 1]a. Anterior segment optical coherence tomography (AS-OCT) showed a posterior polar cataract with a defect in posterior capsule (teardrop sign) [Figure 1]b. The patient underwent RE phacoemulsification with implantation of a three-piece foldable posterior chamber intraocular lens (PCIOL) in the ciliary sulcus with reverse optic capture. Intraoperatively, precautions were undertaken to avoid posterior capsule rent enlargement and vitreous prolapse. Postoperatively, BCVA was 6/6, and a well-centered IOL with typical PC dehiscence was seen [Figure 1]c and [Figure 1]d.
Figure 1: (a) Slit-lamp photograph with retro-illumination showing posterior polar cataract with posterior capsular dehiscence preoperatively. (b) Cirrus anterior segment optical coherence tomography showing thick hyperreflective double convex layer herniating posteriorly through posterior capsule defect preoperatively. (c and d) Slit-lamp photography with retro-illumination and diffuse illumination, respectively. Three-piece intra ocular lens with a defect in the posterior capsule seen postoperatively

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  Discussion Top


Posterior polar cataract (PPC) is characterized as a central bull's eye-shaped opacity located on the posterior capsule. It often presents as one of the most difficult problems for surgeons. Although isolated PC rupture following blunt injury is a rare complication,[1] because of the associated thinning of PC with PPC, traumatic posterior capsule dehiscence can be expected in such cases. In our case, the association could not be confirmed, and the dehiscence might be coincidental.

Preoperatively, several imaging modalities can be used to confirm the integrity of the posterior capsule. These include ultrasound, Scheimpflug imaging, and AS-OCT.[2] Several classification systems for PPC have been described in the literature[3] allowing for prognostication.

It is important to determine this anatomical difference for surgical planning and to assess the likelihood of intraoperative complications. Prevention of extension of the rent and drop of lens material into the vitreous is of imperative importance, and several modifications have been described to prevent the same intraoperatively.[4]

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 Top

1.
Wan W, Hu K, Ji Y, Li C. Management of traumatic cataract with posterior capsular rupture: A case report and in vitro model study. Case Rep Ophthalmol Med 2017;2017:4230657.  Back to cited text no. 1
    
2.
Tabatabaei A, Hasanlou N, Kheirkhah A, Mansouri M, Faghihi H, Jafari H, et al. Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract. J Cataract Refract Surg 2014;40:1092-6.  Back to cited text no. 2
    
3.
Gurnani B, Kaur K. Posterior Polar Cataract. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: http://www.ncbi.nlm.nih.gov/books/NBK574549/.  Back to cited text no. 3
    
4.
Vajpayee RB, Sinha R, Singhvi A, Sharma N, Titiyal JS, Tandon R. “Layer by layer” phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent. Eye (Lond). 2008;22:1008-10.  Back to cited text no. 4
    


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