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• W4383824492 abstract "A 17-year-old girl presented with blurring of vision in the right eye since one year. The patient was born at full-term, normal delivery, and was breast fed. Her mother had no history of radiation exposure during her pregnancy. There was no family history of cataract or any other systemic illness. The best-corrected visual acuity in the right eye and left eye was 20/100 P and 20/20, respectively. The patient's manifest objective refraction was +3.50 DS in the right eye with dual dazzle reflex (myopic at the center and hyperopic in the periphery) and − 0.50 DS in the left eye. Slit-lamp examination of the right eye was normal except for hemispherical protrusion of the posterior lens surface without any opacity in the central region of the lens in the right eye, and fundus examination and intraocular pressure (IOP) were normal. Direct ophthalmoscopy revealed an oil droplet reflex in the right eye. We performed slit lamp (SL) photography to document [Figure 1a and b] and Oculyzer to assess corneal changes [Figure 2a and b]. Scheimpflug imaging of crystalline lens showed protrusion on the posterior lens capsule [Figure 3] in the right eye, whereas the left eye did not show any lenticular bulge. Keratometry values were 43.6 D and 42.04 D in the right eye, and 41.06 D and 41.04 D in the left eye. Wavefront aberrometry with iTrace [Figure 4] was performed to understand aberrations in this ocular condition. Right eye showed − 3 D of astigmatism. In our patient, the preoperative higher order aberrations (HOA) was 7.842 μm root mean square (RMS) in the right eye, which was much greater than in the left eye (0.628 μm RMS). A variation exists in RMS value in normal subjects,[1] and a HOA of 0.15 μm RMS or less is accepted as normal with a 4-mm pupil. Yet, the map of corneal HOAs was homogeneous, suggesting that ocular HOAs originated from the lens.Figure 1: (a and b) Slit-lamp images depicting posterior lentiglobusFigure 2: (a and b) Oculyzer topography images of the right eye and the left eye, respectivelyFigure 3: Scheimpflug imaging of crystalline lens showing protrusion on posterior lens capsuleFigure 4: Wavefront aberrometry with iTraceThe patient was diagnosed with posterior lentiglobus and underwent lens aspiration and foldable intraocular lens (IOL) implantation. On postoperative day 01, the visual acuity was restored to unaided 20/20 with normal IOP, which remained stable at the end of one month. Postoperatively, the patient was started on topical steroids (prednisolone acetate eye drops 1%) in tapering doses and antibiotic drops (moxifloxacin ophthalmic solution 0.5%). Discussion Posterior lentiglobus is a rare disease characterized by unilateral or bilateral conical or hemispherical protrusion of the posterior lens surface with or without central posterior subcapsular lens opacity. Mostly, this disorder is unilateral, sporadic, and occurs at younger ages. The patient's visual acuity gradually decreases as a result of progressive protrusion of the lens, leading to increased irregular astigmatism, lens opacity, or both.[2] The prevalence is about one in one lakh people.[3] It can present as only ocular anomaly or as in association with persistent fetal vasculature stalk, morning glory syndrome, and Alport syndrome.[4] Bilateral disease may be inherited in an X-linked or an autosomal dominant fashion.[5] Early findings of posterior lentiglobus appear ophthalmoscopically as an “oil droplet” in central red reflex. The axial refraction is often markedly myopic, whereas refractive error peripheral to the lentiglobus is often hyperopic. The retinoscopic reflex is often distorted, making preoperative optical correction of refractive errors difficult. If the posterior cortex becomes densely cataractous, accurate identification of opacity by biomicroscopy may be impossible preoperatively. If very opaque cataract exists, ultrasound can aid in making the diagnosis.[5] In patients with lentiglobus with no or mild lens opacity, it is sometimes difficult to judge whether cataract surgery would be beneficial. Wavefront analysis may be helpful in these cases because it can precisely differentiate lenticular HOAs from corneal aberrations and can quantitate the HOAs.[1] The ocular total HOAs and quasispherical aberrations significantly improved postoperatively in our patient. Posterior lentiglobus commonly causes a monocular developmental cataract in the absence of microphthalmia. It may be undiagnosed early in life when the capsular bulge produces a highly myopic and somewhat distorted central lens reflex but no noticeable cataract. However, a delayed diagnosis of posterior lentiglobus may result in dense amblyopia from form vision deprivation, which may be resistant to occlusion therapy after surgery. 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 Hyderabad Eye Institute and Hyderabad Eye Research Foundation. Conflicts of interest There are no conflicts of interest." @default.
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• W4383824492 date "2023-01-01" @default.
• W4383824492 modified "2023-10-14" @default.
• W4383824492 title "A rare case of unilateral posterior lentiglobus" @default.
• W4383824492 doi "https://doi.org/10.4103/ijo.ijo_2183_22" @default.
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