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| OPHTHALMIC IMAGE |
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| Year : 2020 | Volume
: 68
| Issue : 5 | Page : 919 |
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True exfoliation with double delamination of the anterior lens capsule
Vijayalakshmi A Senthilkumar, Mantravadi Shiva Krishna, R Krishnadas
Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research Institute, Madurai, Tamil Nadu, India
| Date of Web Publication | 20-Apr-2020 |
Correspondence Address:
Dr. Vijayalakshmi A Senthilkumar
Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research Institute, Madurai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijo.IJO_1631_19
How to cite this article:
Senthilkumar VA, Krishna MS, Krishnadas R. True exfoliation with double delamination of the anterior lens capsule. Indian J Ophthalmol 2020;68:919 |
A 78-year-old male, farmer by occupation, presented with defective vision in both eyes (OU) with best-corrected visual acuity of 20/120 and 20/200 in the right eye (OD) and Left eye (OS), respectively. He had no history of trauma or infrared radiation exposure. Intraocular pressure were elevated in OU. Slit-lamp examination revealed bilateral nuclear cataracts OS > OD and double delamination of anterior lens capsule (ALC) in OU [Figure 1]a and [Figure 1]b. Fundus examination revealed CDR-0.7 in OD and CDR-0.8 in OS. ASOCT confirmed the presence of split in the ALC. The patient started on antiglaucoma medications followed by uneventful cataract extraction in OS. Adequate cohesive viscoelastics and capsular staining with tryphan blue dye were used during continuous curvilinear capsulorrhexis, as double-ring sign of the ALC was noted. True exfoliation, a rare disorder where anterior layer of lens capsule delaminates and appears as thin fluttering membrane in anterior chamber, was first reported by Elschnig in 1922 in glassblowers.[1] Double delamination, a rare clinical finding, occurs due to different stages in detachment of outer and inner anterior lens flaps and there exists a narrow space between the detached flaps.[2] Predisposing factors for true exfoliation are infrared-radiation, inflammation, trauma, idiopathic, senility, radiotherapy, and laser iridotomy.[3],[4],[5] Association between true exfoliation and glaucoma has been sparsely reported in ethnic Indian eyes. | Figure 1: (a and b) 1a-Slitlamp examination OD showing scrolled flap of anterior lens capsule from 10-7 o' clock and 1b-Slitlamp examination OS showing floating rolled edge of delaminated flap of anterior lens capsule from 9-2 o' clock
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Elschnig A. A detachment of the zonular lamellae in glassblowers. Klin Monatsbl Augenheilkd 1922;69:732-4.  |
| 2. | Teekhasaenee C, Suwan Y, Supakontanasan W, Tulvatana W, Ritch R. The clinical spectrum and a new theory of pathogenesis of true exfoliation syndrome. Ophthalmology 2016;123:2328-37. |
| 3. | Wong AL, Chan TC, Fong AH, Lam BN, Yuen HK. Clinical characteristics and surgical outcomes of phacoemulsification in true exfoliation syndrome. J Cataract Refract Surg 2014;40:82-6. |
| 4. | Lum DJ, Wheeldon CE, Teoh H, McGhee CN. Surgical approach, histopathology, and pathogenesis in cataract associated with true lens exfoliation. J Cataract Refract Surg 2007;33:735-8. |
| 5. | Abe T, Hirata H, Hayasaka S. Double-ring and double-layer sign of the anterior lens capsule during cataract surgery. Jpn J Ophthalmol 2001;45:657-8. |
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