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An otherwise asymptomatic 82-year-old patient with uncorrected visual acuity of 20/25 at distance presents for a routine eye exam in clinic.

Achromobacter Xylosoxidans Endophthalmitis A 79-year-old male with history of Fuchs endothelial dystrophy of both eyes s/p penetrating keratoplasty of both eyes (1980s), repeat penetrating keratoplasty of left eye (2018) and regmatogenous retinal detachment of left eye s/p repair with silicon oil w…

A well-positioned ACIOL with superior nasal iridotomy.

Traumatic anterior dislocation of crystalline lens with Descemet’s folds in the cornea. The patient was treated with lensectomy and vitrectomy. Due to the high myopia, there was no need for secondary intraocular lens or contact lens. The final vision uncorrected visual acuity was 20/30 aphakic.

Bilateral Dense White Cataracts This is a patient with significant complex medical history who presented with hand motion vision secondary to bilateral dense white cataracts. Due to high anesthesia risk given the severity of medial comorbidities including an implanted left ventricular assist device…

Cataract Associated with Ciliary Body Melanoma A patient with recently diagnosed ciliary body melanoma was referred to the BPEI glaucoma service for cataract evaluation. Examination revealed CF vision, a dense white cataract, and ciliary body melanoma that had extended into the iris. The patient ha…

Cataracts and Radial Keratotomy A 69-year-old male presented to Bascom Palmer Eye Institute for glare and blurry vision in both eyes. Exam revealed 20/70 vision in right eye and 20/60 in left eye. Patient had 8 RK incision in both eyes and 2+ NS in both eyes. Patient's preoperative evaluation inclu…

The multicolored appearance is due to needle shaped polychromatic peptide crystals in the cortex or nucleus of the lens. These are not generally visually significant.

Dislocated Intraocular Lens A 74-year-old male presented to the BPEI ER with blurred vision in the right eye for 3 days. He underwent cataract surgery in both eyes 9 years prior in Costa Rica. He denied any other prior ocular history or trauma. Exam revealed VA 20/200+1 in the right eye. IOP was wi…

B-scan ultrasound shows a well circumscribed mass inferiorly with focal hyper-densities. This can mimic a tumor, but the patient has a history of trauma and the object in question is a dislocated crystalline lens.

Epithelial Downgrowth This case presents a 56-year-old female who presented with dramatic decrease of vision over a one-year duration. Patient has previously undergone both eyes corneal transplant, glaucoma drainage device. Patient developed right eye iris cyst, that started growing occupying the a…

Isolated Spherophakia A patient with ocular hypertension and narrow angle was found to have Isolated Spherophakia. She underwent phacoemulsification with a capsular tension ring and intraocular lens in the bag OS. She then had a pars plana vitrectomy with a scleral fixated lens OD. Post-operatively…

In this module, we will look at:




Anatomy of the Lens


Cataracts

The large staple was able to be surgically removed and was performed with phacoemulsification of the lens.

A patient with a history of pseudophakia OS presented with 5 years of low vision and 9 days of pain OD and was found to have light perception only vision and an IOP of 44mmHg OD. She had a granular appearing hypopyon in the anterior chamber corneal edema and a mature cataract. Immunohistological an…

Proliferative Sickle Retinopathy A 3-year-old female was referred to BPEI for treatment of congenital cataracts. After bilateral lensectomy and vitrectomy, the patient was noted to have elevated intraocular pressure. She underwent placement of BGI and was incidentally found to have vitreous hemorrh…

A patient with history of cataract surgery at 19 years old who started noting blurry vision in the right eye found to have a Soemmering ring in the anterior chamber. The ring was removed from the posterior chamber using a scleral tunnel. Surprisingly, a dislocated 3-piece IOL was found. The IOL was…

Retained Lens Fragment A 61-year-old male referred after complicated cataract extraction surgery (phacoemulsification). On exam he was found to have a large piece of retained nuclear fragment in the inferior vitreous. He underwent PPV along with lens exchange with anterior chamber IOL placement. He…

Silicone oil droplets on a silicone intraocular lens

Suprachoroidal Hemorrhage A 76-year-old male that presented to the retina service at Bascom Palmer Eye Institute with left eye pain and elevated intraocular pressure eleven days status post complicated cataract surgery during which he was left aphakic. Of note, the patient was on Aspirin 81mg daily…