How to Deal with Posterior Lenticonus – Two Different Approaches

Introduction: Posterior lenticonus is a rare ectasia of the posterior capsule of the lens and has a prevalence of 1-4/100,000 and is associated with crystalline opacity in 14% of unilateral cases and 9% of bilateral cases. Depending on the degree of opacity and visual impairment, there is a risk of developing amblyopia but the effect on vision is extremely variable. We report two different treatment approaches to the disease. Case Report: The first case is a 10 months male patient with Down syndrome attended for evaluation of cataract with good fixation and no strabismus. Inicially a non surgical treatment was chosen but later he developed an agressive behavior and a posterior lenticone associated with posterior polar cataract was observed, which lead to the decision of a surgical treatment. The second case is a 7 years old patient with history of low visual acuity and posterior polar cataract in the left eye associated with posterior lenticonus discretely displaced superiorly. He was treated with tropicamide and oclusion of the right eye for thirty days. Discussion: The two cases shows how is it possible to manage posterior lenticonus with surgical ou clinical treatments. There is a tendency for patients who underwent cataract surgery to have a better visual acuity improvement compared with patients who did not have surgery, however this data was not statistically significant. Conclusion: The ophthalmologist should be able to recognise this finding during examn and decide wich treatment, surgical or clinical, will bring the best visual outcome for his pacients.