|Year : 2022 | Volume
| Issue : 1 | Page : 118
Nibbled lens: A case of isolated coloboma lentis
M Arthi1, M Periyanayagi2, M Rajakumari3
1 Department of Retina and Vitreous, Rajan Eye Care Hospital, T Ngara, Chennai, Tamil Nadu, India
2 Department of Opthlamology, Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India
3 Department of Ophthalmology, Chettinad Medical College, Chennai, Tamil Nadu, India
|Date of Submission||01-Aug-2021|
|Date of Decision||01-Oct-2021|
|Date of Acceptance||07-Oct-2021|
|Date of Web Publication||22-Mar-2022|
Dr. M Arthi
Rajan eEye Care Hospital, No. 5, Vidyodaya Second Street, T. Nagar, Chennai - 600 017, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Arthi M, Periyanayagi M, Rajakumari M. Nibbled lens: A case of isolated coloboma lentis. TNOA J Ophthalmic Sci Res 2022;60:118
A 23-year-old female came with complaints of defective vision in the left eye (LE) since childhood. She had no significant ocular or systemic history. On examination, the right eye had best-corrected visual acuity (BCVA) of 6/6 and was within the normal limits. LE had BCVA of 6/9 and anterior segment examination showed nasally subluxated crystalline lens with temporal notching, deficient zonules, and subtle phacodonesis [Figure 1]. Posterior segment was within the normal limits. A diagnosis of isolated coloboma lentis was made. Thorough systemic examination including arm span length and cardiovascular examination was normal and ruled out syndromic associations. She was advised glasses in view of good BCVA.
|Figure 1: (a) Slit-lamp photograph showing nasally subluxated clear crystalline lens with temporal notching indicated by black arrows, (b) slit-lamp photograph showing areas of deficient zonules indicated by black asterisk|
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Defective development of the ciliary body and zonules due to failure of closure of fetal fissure during embryogenesis results in release of tension and notching of the lens thereby leading to a lenticular coloboma. It can manifest unilaterally or bilaterally, isolated or in association with retino choroidal coloboma. It is differentiated from subluxated lens by the irregular notched contour of the edge of the lens with deficient zonules. Systemic associations include Marfans syndrome, Sticklers syndrome, and Cohen's syndrome. It may be managed conservatively when the vision is good but may need surgical intervention like phacoemulsification and intraocular lens (IOL) implantation. Scleral fixated or iris fixated IOL implantation maybe required in case of gross subluxation. The surgical intervention is not infrequently complicated by capsular fornix aspiration, extension of zonular dialysis, vitreous prolapse into the anterior chamber, IOL decentration, capsular phimosis, and retinal detachment. The defective development of ciliary body results in abnormal adherence between lens and peripheral retina, thereby causing an increased incidence of retinal detachment in these patients.
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