A 24-year-old male presented with bilateral aphakia, having undergone extracapsular lensectomies and anterior vitrectomies at six months of age. Acuities were 20/40 OD and OS while wearing soft contact lenses and over-refraction glasses to correct astigmatism and near vision. Dilation did not improve retinal viewing due to the presence of a dense Soemmering’s ring, an opaque white layer that forms when the anterior capsule incision adheres to the posterior capsule after cataract surgery.
The phenomenon was first described in 1828 by D.W. Soemmering, who wrote of a ring-like substance behind the iris of cadaver eyes that had undergone cataract removal. It is generally only seen when the pupil is displaced or dilated.
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Posterior capsular opacification (PCO) occurs about 20% to 50% of the time after cataract surgery. During the process, a wound healing response transforms residual lens epithelial cells to myofibroblasts and is associated with collagen deposition. While we normally associate the term PCO with posterior fibrous opacities, it also encompasses opacities such as Elschnig’s pearl and Soemmering’s ring.1
PCO formation is influenced by type of surgery performed and IOL implanted, history of trauma or aphakia, age of the patient (more aggressive in younger patients) and any comorbidities.1 This patient’s history of lens extraction during infancy surely contributed to the finding.
While PCO that occurs in the line of sight may be treated with Nd:YAG capsulotomy, Soemmering’s rings are generally left untouched and are of little consequence. However, there are reports in the literature of pupillary block, corneal decompensation and uveitis-glaucoma-hyphema (UGH) syndrome secondary to dislocated rings. In these cases, iridotomy or surgical removal of the ring is necessary.
Our patient is followed every six months and remains stable, with average intraocular pressures and no evidence of glaucoma, inflammation or corneal disease.
1. Wormstone IM, Wormstone YM, Smither AJO, Eldred JA. Posterior capsule opacification: what’s in the bag? Prog Retin Eye Res. 2021 May;82:100905. Epub 2020 Sep 22.