Case description
A 25 years old girl presented with recent onset deterioration of vision in the left eye (OS) in our OPD. She gave the history of trauma with the stick in OS 2 months back. Best Corrected Visual Acuity (BCVA) was hand movements in the right eye (OD) and no Perception of light (No PL) in OS. Intraocular pressure was 14 mmHg OD and 4 mmHg OS. Detailed anterior segment examination in OD revealed horizontal jerky nystagmus, inferior iris coloboma, keyhole pupil, and focal cataractous changes (Figure 1a). Ocular examination of OS revealed horizontal jerky nystagmus, circumciliary congestion, shallow anterior chamber, multiple sphinter tears with atrophic iris, irregular pupil, and cataractous lens with numerous discrete blood vessels over the lens capsule (Figure 1b). Fundoscopy in OD revealed chorioretinal coloboma involving the disc and macula (Figure 1c) and was obscured in OS secondary to traumatic cataract. Ultrasound B scan depicted lens echoes and moderate to high reflective membranous echoes attached to optic nerve head posteriorly and posterior aspect of lens anteriorly. The membranous echoes in the posterior segment showed limited mobility (Figure 1d). A diagnosis of iris coloboma, focal cataract, and chorioretinal coloboma was made in OD, and iris coloboma, lens neovascularization, traumatic cataract, and retinal detachment were made in OS. This is a very rare and probably the first case of coloboma, cataract, retinal detachment, and lens neovascularization. Surgical intervention was not considered in either eye in view of poor visual prognosis.
Ocular trauma is one of the major yet unrecognized causes of vision loss globally. The complications of blunt ocular trauma like corneal edema, keratitis, hyphema, secondary glaucoma, cataract, and retinal detachment are well known.1. Neovascularization has been reported in various ocular structures like cornea, iris, anterior chamber angle, retina, and rarely in the lenticular stroma. But lens neovascularization has rarely been reported.2