Fibrotic cataract as a sign of posterior capsule violation post vitrectomy

Pseudo second anterior lens capsule during post-vitrectomy cataract surgery: A case report

Purpose

To report the unexpected finding of a membrane resembling a second anterior lens capsule during cataract surgery after previous pars plana vitrectomy (PPV) with silicone oil tamponade for retinal detachment.

Observations

A 26-year-old male with a history of two retinal detachment repairs of the right eye over a 5-month period, presented with decreased vision. The first retinal detachment repair was performed with a 23-gauge PPV and the second with a 25-gauge PPV, scleral buckle and placement of silicone oil. Additional ocular history includes bilateral megalocornea, high myopia, and temporal lens coloboma. Upon presentation, slit lamp exam showed migration of silicone oil to the anterior chamber and a nuclear cataract. A decision was made to perform combined silicone oil removal and cataract extraction with intraocular lens (IOL) implant of the right eye. After capsulorrhexis, hydrodissection of the lens was not completed successfully since the presence of a membrane was detected. This membrane was cut, achieving partial completion of the second capsulorrhexis, which was further advanced using a forceps following the contour of the first capsulorrhexis. The cataract was removed without further difficulty and the IOL was placed into the capsular bag with good centration. The membrane was submitted to pathology, and upon microscopic examination was found to represent fibrocellular tissue with some cells expressing PAX8 and cytokeratin AE1/AE3.

Conclusions and importance

This case reports the unusual finding of a membrane that behaved as a second anterior lens capsule intraoperatively and that expressed novel pathology markers. These findings may better prepare ophthalmologists for similar pathologies they may encounter during capsulorrhexis.