Scheimpflug imaging of pediatric posterior capsule rupture

Abstract

We report a case of an 11-year-old boy who presented two days after blunt trauma to the left eye with a slingshot. On examination his best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left eye. Slit-lamp examination of the left eye revealed a Vossius ring, traumatic cataract, traumatic posterior capsule tear (PCT). The contour of the posterior capsule bulge corresponded to the edges of the PCT. Rotating Scheimpflug imaging (Pentacam 70700:Oculus, Wetzlar Germany) confirmed the traumatic cataract in the region of the PCT visualized as increased lens density at the cortex-vitreous interface. The extent of the PCT in the greatest and least dimensions was documented before and after intraocular lens (IOL) implantation. Intra-operatively, the PCT was evident and phaco-emulsification with an IOL implant was performed. Postoperatively, his BCVA improved to 20/20 in the left eye with a well-centered in-the-bag IOL as found on slit-lamp and Scheimpflug images.

Figure 1

(a) Slit-lamp Photographs (SLP): slit-lamp-examination of the left-eye revealed a vossius ring (black arrow), traumatic cataract, traumatic posterior capsular tear (PCT) (thick arrow) with a bulging-out of lens cortex and a streak of blood at its lower edge (thin arrow) (b) scheimpflug images of rupture (white arrows) along the least dimensions (corresponds to white arrow on SLP). The increased density along the axis of the PCT is evident. (c): Along its greatest dimensions (white arrows correspond to black arrow along the long axis of the tear on SLP)

Figure 2

Preoperative gonioscopy pictures showing a 360-degree angle recession

Figure 3

(a) Well-centered intraocular lens (IOL) post-surgery, (b) postoperative scheimpflug image at four-weeks follow-up showing a well-centered IOL and the margins of the PCT along the short axis, (c) margins of the PCT along the long axis