A 69-year-old Caucasian woman with decreased vision in her right eye was examined on presentation two years ago. This was her first ophthalmic examination since birth.
In her right eye, both her uncorrected (UCVA) and best-corrected visual acuities (BCVA) were 0.1 (in decimal notation). The intra-ocular pressure (IOP) measured by Goldmann applanation tonometer was 14 mmHg. Hardly noticeable temporal paracentral corneal opacity and subtle irregularity of the temporal pupillary margin was noted. In the AC, a straight linear extension extending from behind the iris at the nine o'clock position, reaching the center of the pupil and resembling cilia was visible (Figure 1, Figure 2, Figure 3). The anterior chamber was quiet with no cells or flare and no posterior synechia. With gonioscopy, no anterior synechia or second cilia were noted. Although evidence supported previous injury, she strongly denied any ocular trauma. Because of her nuclear cataract, we admitted her cautiously for cataract surgery, and were prepared for unexpected intra-operative findings.
Cilium removed from the eye. A well preserved cilium survived in the aqueous environment for approximately 50 years.
After filling the AC with an ophthalmic viscosurgical device, the extension was mobilized using capsule forceps and appeared to be longer than the visible portion and half-hidden under the temporal iris. After the extraction, it appeared to be a 7 mm-long cilium, the nature of which was confirmed by pathological examination. After the removal of the cilium, an uncomplicated phacoemulsification and +21.00D posterior chamber intra-ocular lens (Ocuflex, Ocu-Ease Optical Products Inc., Pinole, Canada) implantation was performed. At the first post-operative examination, while again evaluating the trauma history, one of her daughters remembered that approximately 50 years earlier our patient's eye had been struck by her little girl with a dining fork, but no medical care was sought at the time. Ofloxacin (Exocin, Allergan Inc., Irvin, USA) was used for one week and Dexamethasone Sodium Phosphate (Maxidex, Alcon Laboratories Inc., Texas, USA) and Ketorolac tromethamine (Acular, Allergan Inc., Irvin, USA) were used for one month. Her post-operative course was uneventful and visual acuity remained 1.0 for 18 months.
In her other eye, both UCVA and BCVA were 0.3. The IOP was 14 mmHg. The cornea was clear, AC was normal, pupil was regular and central, and a nuclear cataract was present. This eye also underwent an uncomplicated phacoemulsification and posterior chamber intra-ocular lens implantation followed by stable post-operative course with BCVA of 1.0.
J Med Case Reports. 2011;5(527) © 2011 BioMed Central, Ltd.