A 78-year-old male, farmer by occupation, presented with defective vision in both eyes (OU) with best-corrected visual acuity of 20/120 and 20/200 in the right eye (OD) and Left eye (OS), respectively. He had no history of trauma or infrared radiation exposure. Intraocular pressure were elevated in OU. Slit-lamp examination revealed bilateral nuclear cataracts OS > OD and double delamination of anterior lens capsule (ALC) in OU [Fig. 1a and b]. Fundus examination revealed CDR-0.7 in OD and CDR-0.8 in OS. ASOCT confirmed the presence of split in the ALC. The patient started on antiglaucoma medications followed by uneventful cataract extraction in OS. Adequate cohesive viscoelastics and capsular staining with tryphan blue dye were used during continuous curvilinear capsulorrhexis, as double-ring sign of the ALC was noted. True exfoliation, a rare disorder where anterior layer of lens capsule delaminates and appears as thin fluttering membrane in anterior chamber, was first reported by Elschnig in 1922 in glassblowers.[1] Double delamination, a rare clinical finding, occurs due to different stages in detachment of outer and inner anterior lens flaps and there exists a narrow space between the detached flaps.[2] Predisposing factors for true exfoliation are infrared-radiation, inflammation, trauma, idiopathic, senility, radiotherapy, and laser iridotomy.[3,4,5] Association between true exfoliation and glaucoma has been sparsely reported in ethnic Indian eyes.
Figure 1.
(a and b) 1a-Slitlamp examination OD showing scrolled flap of anterior lens capsule from 10-7 o' clock and 1b-Slitlamp examination OS showing floating rolled edge of delaminated flap of anterior lens capsule from 9-2 o' clock
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