Description

This is a retro illumination image of right eye under 10x magnification of a 12-year-old girl with bilateral microspherophakia without any systemic association. You can see a clear crystalline natural lens in globular or spherical shape with intact and stretched zonules attached to the equator of the lens all around visible after full mydriasis. The left eye also had a similar appearance of lens with intact and stretched out zonules. She had a best corrected visual acuity of 6/12 in both eyes with intraocular pressure of 36 in right eye. The high intra ocular pressure is due to pupillary block and angle closure due to the small spherical shape of the crystalline lens. Microspherophakia is a rare, usually bilateral condition characterized by increased anteroposterior diameter and reduced equatorial diameter of the crystalline lens [1]. Microspherophakia may occur as an isolated defect, may be familial or it might be associated with syndromes like Weill-Marchesani syndrome, Marfan syndrome, Lowe syndrome, Homocystinuria, Alport syndrome etc. 51% of patients develops glaucoma leading to optic nerve damage [2]. Nd-YAG Peripheral iridotomy followed by planned clear lens extraction with IOL implantation can treat the high myopia and prevent complications like lens subluxation or dislocation, glaucoma, and corneal decompensation [3].

Figure 1: Retro Illumination image in 10X magnification shows a small spherical crystalline lens with intact and stretched zonules.

Declarations

Declaration of patient consent: The authors certify that they have obtained all appropriate patient’s consent forms. In the form the parents has/have given his/her/their consent for his/her/their daughter’s images and other clinical information to be reported in the journal. The parents understand that their daughter’s name and initial will not be published and due efforts will be made to conceal their identity and anonymity.

Conflict of Interest: Nil.

Source of Funding: Nil.

Acknowledgements: Nil.

References

1. Bitar MS, Farooq AV, Abbasian J. Challenges in Diagnosing Microspherophakia in a Pediatric Patient. JSM Ophthalmol. 2016; 4(1): 1040.
2. Senthil S, Rao HL, Hoang NT, et al. Glaucoma in microspherophakia: presenting features and treatment outcomes. J Glaucoma. 2014; 23(4):262-7.
3. Medhi J, DasGupta S, Bhattacharjee H, Bhattacharjee K. Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma. Indian Journal of Ophthalmology. 2010; 58(1): 67.