Abstract
Purpose
To present a case of bilateral zonular cataract without visual deterioration.
Observation
A 41-year-old Taiwanese Han male presented with severe left ocular pain after being hit by iron filings while working. The iron dust was removed in a local hospital but due to a scleral laceration diagnosis he was referred to our hospital for further management. On examination, best-corrected visual acuity (BCVA) of 20/25 in the right eye and 20/200 in the left eye were obtained, while the before BCVA was 20/25 in the both eyes. The slit-lamp biomicroscopy demonstrated bilateral zonular cataract and left scleral full-thickness laceration with vitreous prolapse. The scleral suture procedure was then performed smoothly and the patient discharged three days later with BCVA in the left eye recovered to 20/30.
Conclusion and Importance
The bilateral zonular cataract without associated systemic disorder is a rare form, which may be found incidentally with no visual symptoms.
List of abbreviations
BCVA
best-corrected visual acuity
1
Introduction
Cataract is the leading cause of reversible blindness throughout the world with various subtypes and degrees. The common clinical presentations of cataract include progressively blurred vision, decrease visual quality and photophobia which depended on the site of cataract formation. Although some risk factors of cataract involving ultraviolet exposure, smoking and use of corticosteroid can be avoided, surgical intervention is always advocated for matured cataract to relieve the visual symptoms.
Zonular cataract, a congenital cataract also known as lamellar cataract, was first described in the late 1800s, which would interfere with visual performance and result in severe visual loss. , The clinical feature of such cataract is an opacified layer with dotted and dusted opacification close to both a clearer central zone and a layer of clear cortex outside the cataract. In addition to visual deterioration, zonular cataract is usually associated with ocular or systemic diseases such as strabismus, Pearson syndrome, trisomy 17 mosaicism, subluxated lens, and traumatic events. , Up to now, there was no report regarding solitary zonular cataract without other co-morbidity. Herein, we report a case of bilateral zonular cataract without visual impairment and comorbidity.
2
Case report
A 41-year-old Taiwanese Han male presented with severe left ocular pain plus foreign body sensation and blurred vision after being hit by iron filings while working. There was no relevant work-related injury, surgical history, family history and systemic disease except hypertension. The iron dust was removed in a local hospital but scleral laceration was discovered with positive Seidel test. As a result, he was referred to our tertiary hospital for further management. On examination, his best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/200 in the left eye, and the intraocular pressure of the left eye was not measurable due to possible eyeball rupture. Both the extraocular movement and pupillary light reflex revealed normal function, while slit-lamp biomicroscopy demonstrated bilateral zonular cataract ( Fig. 1 ) and 5-mm left scleral full-thickness laceration with vitreous prolapse at 4 o’clock, 6mm from the limbus. However, the patient denied any previous symptoms relate to cataract formation including decreased vision, photophobia, halo, glaring, or cloudy vision. In addition, no congenital deformity or disorder was found according to both the patient himself and family. The computed tomography showed no sign of intraocular foreign body ( Fig. 2 ). For the left eyeball rupture, emergent repair of lacerated conjunctiva and sclera with removal of prolapsed vitreous material was performed smoothly, and the tobramycin ointment (Tobrex, Alcon, Cusi, S.A.) was applied two times per day after the surgery. The patient was discharged three days later without further complications. Two weeks after the traumatic accident, the BCVA in the left eye recovered to 20/30.
