Retrolental Opacity: Atypical Manifestation of Lens-Induced Uveitis

The crystalline lens can cause intraocular inflammation when its capsule is ruptured or allows leakage of lens proteins into the anterior chamber, a condition known as lens-induced uveitis (LIU). LIU is a rare form of uveitis and can be classified based on the integrity of the lens capsule. When the capsule is ruptured, the inflammation is called phacoantigenic or phacoanaphylactic uveitis, whereas if the capsule remains intact but leaks proteins, it is termed phacolytic uveitis. Common causes include ocular trauma, previous surgery, or spontaneous rupture in hypermature cataracts. Initial treatment often involves topical corticosteroids, but surgical intervention is frequently required. We report the case of a 76-year-old male patient with a history of bilateral cataracts and prior cataract surgery in the left eye, who presented with decreased visual acuity and ocular pain in the right eye over several weeks. Examination revealed hand motion vision, normal intraocular pressure, fibrinous membranes in the anterior chamber, and a dense cataract with an intact anterior capsule. Ultrasound and ultrabiomicroscopy demonstrated punctiform echoes organized into a central plasmoid body adhered to the iris and corneal endothelium, in addition to a cataract with a dense and mobile central nucleus, absence of cortex, and an intact anterior capsule. After medical management with topical steroids and nonsteroidal anti-inflammatory drugs to control inflammation, the patient underwent phacoemulsification with intraocular lens implantation. During surgery, a dense Morgagnian cataract with an intact capsule was removed. A whitish opacity behind the lens corresponding to anterior vitreous inflammation was identified and extracted via anterior vitrectomy. Postoperatively, inflammation improved significantly, and at two months, visual acuity recovered to 20/25 with complete resolution of ocular inflammation. This case highlights the clinical presentation and management challenges of LIU, specifically phacolytic uveitis. The presence of a hypermature cataract in an eye without prior surgery or trauma strongly supports this diagnosis. While a phacoantigenic mechanism cannot be entirely excluded, the absence of prior lens capsule violation makes it highly unlikely. Recognizing these atypical inflammatory signs and implementing a combined medical and surgical approach are crucial to preserve vision and prevent complications.