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JAMA Ophthalmology Clinical Challenge
June 27, 2019

Posterior Segment Mass in a Woman With a Subluxed Crystalline Lens

Author Affiliations
  • 1Retina Center of Minnesota, Minneapolis
JAMA Ophthalmol. 2019;137(8):945-946. doi:10.1001/jamaophthalmol.2019.1500

A 72-year-old woman was referred for evaluation of a choroidal mass and subluxed crystalline lens in the right eye. The patient had a history of congestive heart failure, cleft lip surgery as an infant, and right eye amblyopia. She reported occasional floaters and flashes in the right eye but denied any ocular complaints in the left eye. On examination, her visual acuity measured 3/200 OD and 20/30 OS, stable compared with her baseline. Her intraocular pressure was 18 mm Hg OD and 14 mm Hg OS. Right eye slitlamp biomicroscopy showed an irregular pupil, aphakia, and a pigmented mass behind the temporal iris (Figure 1A). Ophthalmoscopic examination results revealed a subluxed white cataractous lens in the inferior vitreous base (Figure 1B). An evaluation of the left eye yielded normal results aside for a moderate cataract. B-scan ultrasonography results showed the 2 masses described previously; both were moderately reflective, oval, and separate from the wall of the eye. Ultrasonography biomicroscopy (UBM) confirmed that the temporal mass and the inferiorly subluxed lens were separate from the iris and ciliary body and were similar to each other in size, shape, and density.

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