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• W1967570618 abstract "Dear Editor, Ocular complications have been well documented, secondary to intravenous, inhaled, oral and topical corticosteroids. The incidence of cataract is related to the dose and duration of treatment, but there is considerable inter-individual variation in susceptibility.1 We herein report a case of spontaneous capsular rupture of an intumescent cataract in a young patient, who was on long term, low dose, corticosteroid therapy following renal transplant. A 21-year male presented with progressive dimunition of vision and photophobia of 2 months duration. He had undergone renal transplantation 2 years back for end stage renal disease (chronic glomerulonephritis) and was presently on tablet cyclophosphamide - 75 mg once daily, tablet cyclosporine -100 mg twice daily and tablet prednisolone - 15 mg on alternate days. Visual acuity in right eye (RE) was counting fingers close to face and 20/20 in left eye. Intraocular pressure was 18 mmHg on applanation tonometry in both eyes. Slit lamp examination revealed a clear cornea and shallow anterior chamber, with loose cortical matter. A swollen white cataract with an irregular anterior surface could be seen [Figure 1]. The patient gave no history of trauma. B-scan ultrasonography showed a normal posterior segment. The left eye was normal on examination.Figure 1: Preoperative photograph of a swollen cataractous lens. Note the irregular anterior lenticular surface and flakes of loose cortical matter in the anterior chamber (arrow). The patient underwent surgery, about two weeks after this photograph was takenThe patient underwent R/E phacoaspiration, with endocapsular implantation of the intraocular lens (IOL). Intraoperatively, a vertical anterior capsular tear with fibrotic edge was identified. The posterior capsule was found intact. At 4 weeks follow- up, the patient had best-corrected visual acuity of 20/20, with well centered IOL [Figure 2].Figure 2: Capsular bag implantation of the intraocular lens after phacoaspiration. Note the fibrotic edge of the capsular tear (4 weeks postoperative)There exists a relationship between steroid intake and development of cataract.2 Black and coworkers were the first to report 39% incidence of posterior subcapsular cataract (PSC), in patients treated with corticosteroids.3 Genetic factors are also important determinants in formation of PSC. Progression of PSC tends to diminish with dose reduction or cessation. Corticosteroids have been shown to decrease collagen synthesis in skin remodelling.4 Although the effect of use of steroids on the lens capsule is not known, the lens capsule, being composed of type IV collagen, may have been affected by the long-term steroid intake in the present case. As the lens fibers imbibed fluid and got increasingly hydrated, it might have lead to spontaneous rupture of the lens capsule. To the best of our knowledge, such an occurrence has not been reported before. We do not rule out occult trauma, even though the patient gave no such history on repeated queries. Steroid- induced cataracts may have an increased propensity for spontaneous capsular rupture at the intumescent stage. Such cases should be kept on regular follow-up and early surgery should be planned for intumescent cataracts." @default.
• W1967570618 created "2016-06-24" @default.
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• W1967570618 date "2006-01-01" @default.
• W1967570618 modified "2023-10-10" @default.
• W1967570618 title "Spontaneous rupture of the anterior lens capsule" @default.
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• W1967570618 doi "https://doi.org/10.4103/0301-4738.27089" @default.
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