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Bilateral electrical cataract
  1. USHA K RAINA,
  2. DEVEN TULI
  1. Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India
  1. Dr Usha K Raina, 427 Hawa Singh Block, Asiad Village Complex, New Delhi-110 049, India.

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Editor,—Electric trauma is not uncommon in India where majority of the population lives in the rural setting. Few cases of electric cataract have been reported in literature probably because few patients survive the high voltage of current that induces cataract formation. Most patients with electric cataract have no subjective complaints early on but become aware of the reducing visual function several months later.1

CASE REPORT

A 26 year old man complained of gradual and painless diminution of vision in both eyes, right more than left, for the past 2–3 years. There was a history of an overhead high tension electric transmission cable accidentally falling on the patient’s head 4–5 years earlier. This had resulted in immediate burn to the scalp. The patient was visually asymptomatic till about 1 year after the mishap, when he began to notice the gradual fall in vision that had progressed to its present state.

Corrected visual acuity was 20/200 right eye and 20/60 left eye. A 15 × 2.5 cm linear, sagittal scar extending from the frontal to the occipital region of the head was noticed. The lids, conjunctiva, cornea, and pupils showed no abnormality in either eye. Fundus examination was unremarkable. Slit lamp examination revealed multiple, mid-peripheral snowflake-like anterior subcapsular lens opacities in both eyes, right greater than left. In the right eye some of these opacities were seen encroaching into the visual axis and additionally a few posterior subcapsular opacities were noticed (Fig1).

Figure 1

The characteristic anterior subcapsular lens opacities. (A) Right eye, (B) left eye.

In view of the history of electrical injury and classic location and typical appearance of the lens opacities, a diagnosis of bilateral electric cataract was made. Extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation was undertaken in both eyes, right eye first followed 3 months later in left eye. The intraoperative and postoperative course were uneventful and the patient has achieved corrected visual acuity of 20/20 in both eyes.

COMMENT

Involvement of the lens exclusively, sparing other ocular structures is rare. This case documents such a possibility and also highlights the salient features involving electric trauma to the lens. The scalp burn in this case represents the entrance wound for the electrical energy but the lack of an exit wound makes this case particularly peculiar. Both entry and exit sites for the electric current have been reported by all previous authors.

The excellent surgical results noted in both eyes of this patient are in keeping with the similar result reported by Portelloset al. 2 This observation should encourage the ophthalmologist to undertake surgery for electric cataract, where necessary, without any undue concern.

References

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