Shifting crystalline pseudohypopyon secondary to lens absorption with spontaneous openings in the anterior lens capsule

Abstract

This is the first reported case of a crystalline pseudohypopyon presenting as a layer of "snowdrift deposits" that settled inferiorly in the anterior chamber of the eye of a 55-year-old man and was associated with freely floating crystals in the aqueous humor, producing a "snowy Christmas Eve" appearance. The cause was spontaneous openings in the center of the anterior capsule with leaching of the crystalline substance into the anterior chamber. A dense membranous cataract was left after the lens material was partly absorbed. There was no history of trauma, surgery, or known systemic disease, and the patient presented with a unilateral, mobile, 4.0 mm white pseudohypopyon with no global pain, photophobia, or lacrimation. Although the eye was not injected on admission, repetitive head shaking resulted in dusky-red perilimbal hyperemia. A B-mode ultrasound revealed an advanced retinal detachment, and electroretinographic recordings were undetectable. Visual acuity decreased to hand motions in the affected eye, and the patient ultimately required anterior chamber paracentesis. Such sediments should be differentiated from other forms of true or pseudohypopyons because the course, treatment, and prognosis are different for each.

Management of cataracta membranacea in a geriatric patient

“…Spontaneous openings in the anterior lens capsule may also cause this entity. 4 The precise etiology of cataracta membranacea in the present case is not clear. However, age of the patient and absence of a history of trauma suggests that cataracta membranacea was secondary to a hypermature or a Morgagnian cataract.…”

“…The condition ischaracterized by liquefaction and subsequent absorption of lens fibers within the capsular bag and adhesion between the anterior and posterior capsules. [1][2][3][4] The cataracta membranacea morphologically resembles posterior capsule opacification (PCO). 2,3 However, in cases of cataracta membranacea, the naturally occurring lens disappears without surgical intervention.…”

Cataract surgery in a patient with unilateral cataracta membranacea

“…A liquefied hypermature lens may gradually lose fluid and diminish in volume leaving a membranous residual lens over a period of time. This phenomenon can occur in patients with traumatic or hypermature and leaking Morgagnian cataracts and also after spontaneous openings in the anterior lens capsule [4].…”

“…Congenital membranous cataracts have been reported to occur in association with congenital rubella and as a part of various syndromes such as Hallermann-Streiff-Franç-ois syndrome, Lowe syndrome [2] and MarinescoSjögren syndrome [5], and also as part of a syndrome complex with dentigerous cysts and multiple fibrolipomata [6]. In adults it has been reported to occur in association with bilateral retinal detachment [7], aniridia [8], and secondary to spontaneous openings in the anterior capsule [4]; however, it may not necessarily be associated with any systemic disease [9], such as the current case. The reports of IOL implantation in CM are rare in English literature and only three reports were found on literature review [3,9,10].…”

“…Cataracta membranacea (CM) or membranous cataract is a rare condition characterized by degenerated lens fibers which after liquefaction and subsequent absorption comprise remnants of anterior and posterior capsules and fibrous tissue [1][2][3][4]. This condition, in which the naturally occurring lens is absent from the eye without any surgical intervention, has previously been described in literature as ''pseudoaphakia'' and has a morphological appearance similar to posterior capsular opacification (PCO) [1,3].…”