Case History
A 14-year-old girl presented with the chief complaint of night vision disturbance. The patient had good visual performance at day light, but she has complaints of significant glare in dim light many years ago. The best-corrected visual acuity was 20/32 in the right eye and 20/25 in the left eye. The refractive error was − 5–1.25 × 160 in the right eye and − 4.50–0.75 × 20 in the left eye. The acuity was nearly the same in the dim room condition but with significant glare. Slit lamp examination with undilated pupil revealed almost no abnormality, except a spoke-like opacity in the inferior part of the crystalline lens in the right eye. After pupil dilation, dense whitish peripheral lens opacity was observed in both eyes, which has a doughnut-like shape. The central part of both lenses was almost clear (about 4–4.5 mm). Other examinations were within normal limits. Anterior-segment photographs were taken and written approval was obtained from the patient and her parents for the use of photographs for academic purposes [Figures 1 and 2].
Figure 1.
Slit photograph OD, doughnut-shaped cataract in the right eye
Figure 2.
Slit photograph OS, doughnut-shaped cataract in the left eye
The patient was otherwise in good general health. The past medical history was negative for any metabolic, infectious, or genetic disorders. There was no history of any congenital ocular condition in the family. There are no siblings to be examined; the ocular examination of parents was normal. An internal medicine consult to search for any systemic or metabolic disorders revealed no abnormality.
Congenital cataract (CC) is seen in 40–60 of 100,000 live births. The majority of bilateral CC results from several genetic conditions, but the isolated cases are not uncommon.[1] In our patient, the main location of cataract was in the peripheral part of lens, unusual for a CC. There are several case reports of “ring-shaped” and “disc-shaped” cataract, mostly from old literature. Collins and Mayou described congenital disc-shaped cataracts with a central clear, midperipheral opaque and far peripheral clear zone.[2] Von Szily stated that ring cataract develops because of resorption of central nucleous and secondary disintegration of peripheral part.[3] There is a report of ring-shaped cataract in 16 members of a Peruvian family, all of which had concurrent lens subluxation.[4] A ring-shaped cataract was also reported in the cases with chronic trinitrotoluene poisoning in Danish arm factory workers, which contains triangle-like opacities in the lens periphery, with clear far periphery of the lens.[5]
The patient and parents were consulted for the possibility of cataract surgery. They had decided to defer the surgery for a later time. A regular follow-up was scheduled for the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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