Tear-drop sign of posterior capsule dehiscence on Scheimpflug imaging

Correspondence

737

Sir,

Tear-drop sign of posterior capsule dehiscence on

Scheimpug imaging

Posterior polar cataract is associated with deciency of the posterior capsule in 1126% cases1 leading to high incidence of capsule rupture and potential vitreous loss.2 Identication of the posterior capsule defect (PCD) preoperatively is an obvious advantage that aids in surgical planning.

Case reportA 23-year-old man presented with bilateral progressive diminution of vision for 3 months. On examination his BCVA was 20/200 OU. Slit-lamp examination revealed a posterior polar cataract in both eyes with central conical

projection into the vitreous more prominent in the left eye (Figure 1a and b). Scheimpug imaging (Pentacam 70700: Oculus, Wetzlar, Germany)3 (Figure 2a and b) in the left eye revealed a posterior lenticonus simulation with dehiscence in the posterior capsule giving a tear drop or hanging drop appearance (Figure 2b). The corresponding lens spike in the left eye is broader and irregular than in the right eye. The patient underwent phacoemulsication in the left eye and a central PCD was noted as highlighted on Scheimpug photography. The vitreous face was intact. A three-piece Tecnis Z9000 (AMO Inc., Santa Anna, CA, USA) IOL was implanted in the bag. The right eye underwent uncomplicated phacoemulsication and no PCD was noted.

Posterior polar cataracts may be associated with remnants of the hyaloid system or the tunica vasculosa lentis.4 An important feature of posterior polar cataract is a signicant incidence of extreme capsule weakness or perhaps even absence in the area of polar opacity, which is difcult to identify in the presence of dense polar cataracts.1,4,5 Scheimpug photography identied the preexistent PCD, in our case evident as protrusion through the PCD producing...