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• W2004657537 abstract "We had a case of intralenticular hemorrhage similar to the one reported by Hwang et al.1 It highlights the unusual presence of a hemorrhagic clot within the lens. This is rare in the absence of an obvious pathological anomaly. Case Report A 10-year-old boy presented with a gradual progressive painless diminution of vision in the right eye over the previous 5 months. There was no history suggestive of trauma, ocular surgery, metabolic disease, ocular inflammation, or other systemic illness. On examination, a total cataract with perception of light with an accurate projection of rays was noted in the right eye. The anterior segment, intraocular tension, and gonioscopy were unremarkable. Detailed slitlamp examination showed a brownish–red hemorrhagic deposit inferonasally inside the lens, although no vessels were seen (Figure 1). Ultrasonography revealed an anechoic posterior segment with similar axial lengths in both eyes. The fellow eye was normal. Phacoaspiration was performed with intraocular lens implantation under general anesthesia. The cortical material and the blood clot could be easily aspirated. Part of the posterior capsule behind the hemorrhagic clot was thickened but intact and it was left undisturbed. The postoperative visual acuity was 10/120, improving to 20/30 with best refractive correction. The detailed postoperative fundus examination revealed no abnormality. Discussion Intralenticular hemorrhage is an infrequent occurrence. It has been described following cataract2 and glaucoma surgery3–5 and neodymium:YAG peripheral iridotomy6 and subsequent to ocular trauma.1,7,8 In all these cases, the source of blood was iris vessels and the blood entered the lens through a breach in the capsule integrity at the time of surgical or ocular trauma. The possible etiology of such an occurrence is of interest. Although the patient was not forthcoming with the history of trauma as in Hwang et al., there is a possibility that he may have had trauma in this eye. However, this was negated by the absence of tell-tale signs of blunt or penetrating trauma on the ophthalmic evaluation. With no signs of ocular inflammation and blunt/penetrating trauma, the origin could be congenital or developmental. Embryologically, the developing lens is surrounded by capillaries derived from the hyaloid artery posteriorly and annular vessels anteriorly. After reaching its full development, this tunica vasculosa lentis atrophies at around 3 to 4 months of gestation. The vasculature anteriorly constituting the pupillary membrane and posteriorly of the posterior capsule finally regresses during the fifth month of gestation, whereas the blood flow in the hyaloid artery ceases at 7 months of gestation and the vessel is almost completely atrophied by birth.9 We believe the source of the blood must have been the hyaloid vessels for the following reasons: First, the blood extended close to the posterior capsule as observed preoperatively; it was inferonasal in the lens, corresponding to the nasal location of the hyaloid artery; and hyaloid vasculature is late to regress. Considering that the lens was of normal shape and size otherwise, we believe intralenticular hemorrhage must have occurred later during development and remained unabsorbed. Since it was localized away from the visual axis, the child gained good vision postoperatively. This case highlights a peculiar and yet unreported possible cause of intralenticular hemorrhage. Mayank S. Pangtey MD Sudarshan Khokhar MD Parul Sony MD Anita Panda MD Harinder Singh Sethi MD Parijat Chandra MD New Delhi, India" @default.
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• W2004657537 date "2003-05-01" @default.
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• W2004657537 title "Posttraumatic Neovascularization in a Cataractous Crystalline Lens" @default.
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• W2004657537 doi "https://doi.org/10.1016/s0886-3350(03)00310-9" @default.
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