Abstract
Purpose
We report five cases (seven eyes) of true exfoliation during an 18-month period. Of the two bilateral cases, the first was identified immediately before cataract surgery and the second spontaneously developed a split in the anterior capsule just before capsulorrhexis, mimicking a partial capsulorrhexis. In the three unilateral cases, true exfoliation was noted during the first examination.
Methods
Vision blue aided uneventful capsulorrhexis differentiating its edge from the true exfoliation edge, and in the first two cases, the anterior capsule was sent for histopathology and ultrasound of the fellow eye was requested.
Results
Ultrasound and histopathology demonstrated lamellar separation of the anterior portion of the lens capsule, confirming the diagnosis of true exfoliation. Cataract surgery by phacoemulsification was uneventful in all cases
Conclusion
True exfoliation of the lens capsule can masquerade as a partial capsulorrhexis and should be looked for before surgery and immediately before capsulorrhexis to avoid creating a partial thickness capsulorrhexis and its related surgical complications. No zonule weakness was appreciated in our cases. To our knowledge, the spontaneous occurrence of a curvilinear lamellar capsular dehiscence with a flap before capsulorrhexis has not been reported before. This series highlights that cataracts associated with true exfoliation of the lens capsule can be safely operated, with the help of vision blue, by routine phacoemulsification without having to convert to the extracapsular technique.
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Acknowledgements
We thank Professor Luthert and Mr Robin Howes at The Department of Pathology, The Institute of Ophthalmology, London, for the histology report of true exfoliation of the lens capsule and the Department of Visual Sciences, Birmingham Midland Eye Centre, Birmingham, for the ultrasound results. Mr Prasanna Pimpalnerkar, Microsoft Certified professional for his technical support.
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Kulkarni, A., Al-Ibrahim, J., Haider, S. et al. Phacoemulsification in true exfoliation of the lens capsule: a case series. Eye 21, 835–837 (2007). https://doi.org/10.1038/sj.eye.6702441
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DOI: https://doi.org/10.1038/sj.eye.6702441
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