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A 75-year-old African-American man presented with a red right eye. He had sustained blunt trauma to this eye in 1967 with posterior dislocation of the lens. He had done well for 44 years until two months prior to presentation, when he noticed a white spot and developed worsening blurred vision and sharp pain in the eye.
BCVA in the eye was counting fingers at 3 feet, and IOP was 24 mmHg. Anterior segment exam revealed localized epithelial microcystic edema in the area where a worm-shaped white anterior chamber mass embedded in vitreous abutted the endothelium. The iris was irregular secondary to the prior trauma. Dilated exam revealed no evidence of posterior lens fragments or retinal pathology.
This white mass represented the calcified remains of the lens, which had become lodged in the anterior chamber. After initial control of the IOP, the patient underwent a pars plana vitrectomy/lensectomy. Because of calcification, the fragments could not be broken up or removed with the fragmatome, so they were taken out through a corneal incision. The patient did well postoperatively, improving to his baseline of 20/100 with a 12-D lens.
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