Histopathologically proven siderotic cataract with disintegrated intralenticular foreign body
A 32-year-old Indian man presented to the emergency department with 3 days’ history of left eye pain, redness and blurring of vision. He has no past medical history, but gave a preceding uncertain history of foreign body hitting his left eye 6 months ago whilst standing beside a co-worker who was hammering metal. He was given eyedrops by a company doctor and did not seek further treatment even though he continued to have blurring of vision for 3-4 months subsequently.\nOn examination, his visual acuity was 6/6 in the right eye and hand movement in the left eye. There was no relative afferent pupillary defect and intraocular pressures were normal bilaterally. Examination of the right eye was normal; however, in the left eye, there was a linear cornea scar superiorly and a siderotic white cataract with small breach in the anterior lens capsule. There were brownish orange pigment clumps on the anterior lens capsule suggestive of siderotic cataract clinically []. There were clumps of white lens matter inferiorly in the anterior chamber but the anterior chamber was otherwise deep and quiet with no signs of a hypopyon. No intraocular foreign body was visualized via slit-lamp examination and gonioscopy. Ultrasound B-scan showed moderately dense mobile vitreous opacities with posterior vitreous detachment, with no retinal tear or detachment. On low gain, no intralenticular foreign body was seen and the posterior capsule was intact []. Orbital X-ray [] and computed tomography scan [] did not show any retained intraocular foreign body.\nElectroretinography examination was deferred at this stage and was decided to remove cataract and implant intraocular lens with intraoperative fundus examination for siderotic changes on the retina. After 1 week of treatment with eyedrops to reduce the anterior chamber inflammation, he underwent an uneventful left cataract aspiration and implantation of posterior chamber intraocular lens under regional anesthesia. Fundus examination was performed intraoperatively and it did not show any retained intraocular foreign body, retinal detachment, retinal tear or vitreous hemorrhage. As there were no siderotic changes on the retina, electrophysiologic examination was not performed in postoperative period as well. Anterior lens capsule was sent for histology, which showed hemosiderin deposits []. Special stain like Prussian blue was also used to confirm the presence of iron pigments in the anterior capsule. His final visual acuity was 6/7.5 with intraocular lens in situ and stable retina.