Anterior Hyaloid or Moon Surface?



The authors present the case of a 45 years old female that presented to our emergency room with left eye acute painless vision loss for two days. The ophthalmological examination revealed a visual acuity of 2/10 and an intraocular pressure of 10 mmHg. The anterior chamber, the iris and the pupil didn’t present any abnormalities. The observation of the retina after dilation of the pupil, revealed a superior reghmatogenous retinal detachment with macula-off. The lens was clear and transparent. With indirect ophthalmo scopy and the use of the three mirror contact lens we could see a peripheral retinal tear at 10 o’clock. We performed a small gauge pars plana vitrectomy (23 gauge), endolaser to treat the peripheral retinal tear and SF6 gas tamponade, with no complications. Ten days after the surgery the patient presented in our department with painful red eye and vision loss. Slit lamp observation revealed multiple dense opacities behind the crystalline lens, looking like a subcapsular cataract. Fundus visualization was impossible. So, an ultrasound exam was performed, showing hyperechogenic images in the anterior hyaloid (or lens posterior capsule?) and peripheral vitreous. The ultrasound exam also revealed the presence of peripheral choroidal detachments. We decided to perform a cataract surgery and revision of vitreoretinal surgery. During the procedure, we observed that the anterior hyaloid was opacified and adherent to the posterior lens capsule. “It looked like the moon surface”. Perip heral residual vitreous was inflammatory. It was very difficult to separate the anterior hyaloid from the posterior lens capsule, without rupture or other complications. We solved this problem with the aid of an ophthalmic viscosurgical device. Then, we completed the vitrectomy of the anterior hyaloid and the remaining peripheral vitreous. We collected a sample of the inflammatory vitreous. The microbiological study was negative. After the vitrectomy, we introduced an intraocular lens, in the bag. At the end, we performed fluid/air exchange and tamponade the eye with silicone oil, with good anatomic and functional results.



David Martins
Ines Matias
Setubal, Portugal
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