Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2019  |  Volume : 67  |  Issue : 10  |  Page : 1782-

Reply: Posterior lenticonus with persistent fetal vasculature


Sudarshan Khokhar, Chirakshi Dhull, Karthikeyan Mahalingam, Pulak Agarwal 
 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Correspondence Address:
Dr. Chirakshi Dhull
Room No 486, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi - 110 029
India




How to cite this article:
Khokhar S, Dhull C, Mahalingam K, Agarwal P. Reply: Posterior lenticonus with persistent fetal vasculature.Indian J Ophthalmol 2019;67:1782-1782


How to cite this URL:
Khokhar S, Dhull C, Mahalingam K, Agarwal P. Reply: Posterior lenticonus with persistent fetal vasculature. Indian J Ophthalmol [serial online] 2019 [cited 2019 Nov 19 ];67:1782-1782
Available from: http://www.ijo.in/text.asp?2019/67/10/1782/267469


Full Text



Sir,

We have reported for the first time a rare case of bilateral posterior lenticonus with bilateral persistent fetal vasculature (PFV).[1] Both eyes of the patient have subtle findings suggestive of PFV. If not looked at carefully and specifically, PFV may be missed out. This case adds evidence to existing hypothesis that PFV may have a role in pathogenesis of posterior lenticonus.[1],[2]

The case mentioned in the letter [3] (“Progressive posterior lenticonus with total lenticular opacity”) is of a child with of posterior lenticonus with total cataract. There is no association of PFV noted. The case is well documented, and diagnosed and managed properly. However, we would like to add a few things.

It is difficult to distinguish posterior lenticonus from posterior capsular defect with ultrasonography alone. Performing ultrasound biomicroscopy (UBM) with 35 MHz probe adds valuable information in surgical planning as lens curvature and continuity of posterior capsule can be clearly seen.[4],[5]

During surgery, since posterior capsule is thinned out, precautions need to be taken to avoid inadvertent capsule rupture. Gentle hydrodissection, low flow settings and bimanual surgery are recommended [6] “Jellyfish sign” mentioned in the letter is due to anterior and posterior bulging of posterior capsule with change in IOP and flow rate.[7] It may also be seen in cases of posterior capsular defect where anterior hyaloid face is intact. Posterior capsulorhexis can be performed depending on the age and IOL can be implanted in the bag or sulcus based on size of posterior capsulorhexis and area of thinning. With due precautions, complications during surgery are rare and anatomical outcomes are good.[8]

Visual outcomes may be affected by presence of amblyopia in long standing cases. Hence, in addition to cataract extraction, emphasis has to be laid on amblyopia therapy post-operatively for visual rehabilitation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Khokhar S, Dhull C, Mahalingam K, Agarwal P. Posterior lenticonus with persistent fetal vasculature. Indian J Ophthalmol 2018;66:1335-6.
2Kilty La, Hiles Da. Unilateral posterior lenticonus with persistent hyaloid artery remnant. Am J Ophthalmol 1993;116:104-6.
3Kasturi N, Elamurugan V. Comment on: Progressive posterior lenticonus with total lenticular opacity. Indian J Ophthalmol 2019;67:1780-1.
4Kaya A. Preoperative usage of ultrasound biomicroscopy in pediatric cataract. Arq Bras Oftalmol 2016;79:62.
5Khokhar SK, Pillay G, Dhull C, Agarwal E, Mahabir M, Aggarwal P. Pediatric cataract. Indian J Ophthalmol 2017;65:1340-9.
6Wilson ME, Trivedi RH. Intraocular lens implantation in pediatric eyes with posterior lentiglobus. Trans Am Ophthalmol Soc 2006;104:176-81.
7Ganesh S, Brar S, Chopra K. Jellyfish sign for intraoperative identification of posterior lenticonus. Int Ophthalmol 2017;37:1239-41.
8Mistr SK, Trivedi RH, Wilson ME. Preoperative considerations and outcomes of primary intraocular lens implantation in children with posterior polar and posterior lentiglobus cataract. J AAPOS 2008;12:58-61.