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    Dislocation of Hypermature Cataract  

    By Homer H. Chiang, MS, and Jon­athan D. Paul, MD, University of Vermont College of Medicine, Burlington
    Photo by Susana Teixeira, Hospital Prof. Fernando da Fonseca E.P.E., Lisbon, Portugal

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    Dislocation of Hypermature Cataract

    A 46-year-old man presented to the emergency room af­ter a family member noticed a white discoloration in his left eye. He denied pain but re­ported a pressure sensation in the eye. He indicated that he had been “head banging” at a concert the night before. His past ophthalmic history by his own report was significant for retinal detach­ment in the left eye in childhood, with no light perception (NLP) since he had been treated with laser at the age of 5. No records were available. 

    Examination of the left eye revealed a pre­phthisical eye with band keratopathy of the cornea. Intraocular pressure was 7 mm Hg, and vision was NLP. There was complete dislocation of a hypermature cataract into the anterior cham­ber. The lens nucleus appeared to be absent. Lens material in the anterior chamber appeared to consist of fragments of opacified cortex with an intact capsule. No cell or vitreous was ap­parent in the anterior chamber. Funduscopy of the left eye was not possible. B-scan ultrasound showed an anteriorly dis­located lens and a retinal detachment. Examination of the right eye was unremark­able. 

    Options, including ob­servation and dilating and repositioning, were discussed with the patient. He elect­ed lensectomy to prevent corneal decompensation.  

    The patient was started on 2% pilocarpine to trap the lens in the anterior chamber. Len­sectomy with anterior vitrectomy was per­formed through a clear corneal incision. Because the calcified cortical material could not be removed with coaxial irrigation/aspiration or the anterior vitrector, it was removed manually with forceps. The patient did well postoperatively with­out complication and remains NLP. 

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