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Last Month’s Blink

Posterior Lenticonus: “Fishtail” Appearance

Written by Jitender Jinagal, MS, Gaurav Gupta, MS, and Jagat Ram, MS, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Photo by Jitender Jinagal, MS.

A 17-year-old boy presented with com­plaints of blurred vision in his left eye. Best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/60 in the left. In both eyes, the slit-lamp exam revealed a conical protrusion of the posterior surface of crystalline lens associated with cataractous changes, giving a “fishtail” appearance (photo); these changes were more prominent in left eye. Scheimpflug imaging confirmed the finding of posterior lenticonus in both eyes. Phacoemulsification was performed, followed by implantation of a posterior chamber IOL in his left eye; his post-op BCVA was 20/20.

Posterior lenticonus is a cone-shaped pro­trusion of the crystalline lens into the vitreous cavity.¹ It can be part of an inherited syndrome, such as Alport or Lowe syndrome, or it can be sporadic, as in this case. There is a genetic defect in the synthesis of type IV collagen,² which can cause fragility in the basement membrane of the lens capsule.

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