International Journal of Clinical & Medical Images

Clinical-Medical Image

An 82-year-old lady with a past history of left vitrectomy, phacoemulsification and intraocular lens 3 years earlier for a macular hole attended for her right eye cataract surgery. On the table, it appeared that she already had a continuous curvilinear capsulorrhexis (CCC) [1] performed in her right eye (Figure 1). This was not observed pre-operatively. Medical notes were rechecked to confirm it was a virgin eye. Surgery was recommenced. CCC (white arrowed) was completed to show the ‘double-ring’ (Figure 2) followed by the disappearance of the ‘double-ring’ sign with the removal of nucleus and soft lens matter, with only the actual CCC remaining (Figure 3) and insertion of intraocular lens (Figure 4). The lens nucleus-cortex interface may, very rarely, mimic the presence of a CCC in a virgin eye. Should the surgeon encounter such unique presentation, medical notes should be double-checked, and if possible directly with the patient, before recommencing surgery. Pre- and peri-operative planning such as the use of intracameral dye e.g. trypan blue [2] may facilitate the surgeon in visualizing the anterior capsule and confirm with confidence that prior surgery or CCC was certainly not performed.

Keywords: Vitrectomy; Curvilinear capsulorrhexis. Declaration of Interests Both authors have no conflicts of interest to disclose.

References

[1] Sharma B, Robin GA, Tarun A, Tom A, Rasik BV (2019) Techniques of anterior capsulotomy in cataract surgery. Indian J Ophthalmol 67: 450-451. [2] Vianna LMM, Cohen MJ, Muccioli C, Lima A, Sousa-Martins D, et al. (2014) Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification. Arq Bras Oftalmol 77: 173-177.