Lens capsular bag dislocated into the anterior chamber following calcific phacolysis in an immunocompromised patient.

Abstract

AbstractPurpose Calcific phacolysis, a rare clinicopathologic entity that develops in long‐standing unilateral traumatized or cataractous lenses, results in complete liquefaction of cortex, which escapes through an intact lens capsular bag. Cytomegalovirus (CMV) retinitis is associated with high risk of cataract but calcific phacolysis had never been described in patients with this opportunistic infection.Methods Interventional case report showing a calcific phacolytic process with dislocation of lens capsular bag into the anterior chamber.Results A 48‐year‐old man with a history of HIV, chronic hepatitis C, and CMV chorioretinitis, presented with left eye pain and redness for three days. Slit‐lamp biomicroscopy revealed the presence into the anterior chamber of a free‐floating lens capsular bag associating calcified lens particles. The patient underwent irrigation and aspiration to remove this spontaneously dislocated material and symptoms resolved after one‐month topical antibiotic‐steroid therapy.Conclusion Phacolysis has been described as the breakdown of a hipermature cataract, causing an antigenic reaction to the proteins released into the anterior chamber through an intact lens capsular bag, in this case displaced anteriourly. Although it is thought to be a slow process, sometimes a cataract can rapidly mature and become phacolytic. To the best of our knowledge, this appears to be the first case of spontaneous phacolysis over the course of only three days in a patient with ocular history positive for a CMV chorioretinitis 15 years ago.