Dislocated Sömmering Ring with Decompensated Cornea Presenting 14 Years After Lens Aspiration and Anterior Vitrectomy: A Case Report and Literature Review.

ABSTRACT

BACKGROUND A Sömmering ring is a post-cataract opacity (PCO) formed due to the adhesion of anterior capsule edges to the posterior capsule. It is mostly associated with aphakic cases but has also been reported in pseudophakic eyes. It becomes clinically important when dislocation occurs. The purpose of this manuscript was to report a case of anterior dislocation of the Sömmering ring 14 years after lensectomy for congenital cataract. CASE REPORT We describe a 20-year-old man who presented to the emergency room with pain, photophobia, redness, and blurry vision in the right eye. The patient was known to have bilateral amblyopia and had undergone bilateral lens aspiration and anterior vitrectomy without intraocular lens (IOL) implantation 14 years prior to presentation. On examination, the intraocular pressure was normal, the conjunctiva had moderate diffuse injection, and the cornea had 2+ diffuse edema with bullae and Descemet folds. The anterior chamber was deep with semilunar-shaped solid white material consistent with the Sömmering ring in the anterior chamber. On dilated fundus examination, the view was hazy, and B-scan ultrasonography indicated highly reflective material in the vitreous cavity and a flat retina. CONCLUSIONS Sömmering ring in the anterior chamber can be inflammatory and especially damaging to the corneal endothelium. If this complication occurs, timely intervention in the form of surgical removal is crucial to prevent endothelial cell loss and corneal decompensation. A thorough cleaning of the cortical matter after lens removal during primary surgery can reduce the risk of secondary formation of PCO. Implantation of IOL in myopic eyes can be considered to reduce the risk of Sömmering ring formation in the future and its complications.