An 86-year-old man complained of decreasing vision in his left eye. He has had poor vision in his right eye since he was a child. Visual acuity was counting fingers at 1 ft OD and 20/60 OS. Slit-lamp examination revealed bilateral brunescent cataracts. Also present bilaterally was a thin, clear membrane that protruded through the pupil to float in the anterior chamber. The membrane was attached to the anterior lens capsule and was best seen with retroillumination (Fig 1). The patient denied any history of ocular trauma or occupational exposure to excessive heat or infrared radiation. He underwent uneventful extracapsular cataract extraction with posterior chamber intraocular lens implantation in his left eye. The anterior lens capsule was sent for analysis.
Histopathologic examination revealed an eosinophilic amorphous substance with a periodic acid-Schiff—positive membrane. At high magnification the membrane showed multiple splitting of the anterior lens capsule (Fig 2).
True lens exfoliation
Fiore PM, Shingleton BJ. Senile Lens Exfoliation. JAMA. 1990;264(21):2755. doi:10.1001/jama.1990.03450210055032