Focal multistriae: Postoperative finding in posterior lenticonus patients Robert H. Osher, MD, Frederico F. Marques, MD, Daniela M.V. Marques, MD, Robert J. Cionni, MD A brother and sister presented with a history of difficulty reading fine print and an intolerance to glare. Family history was positive for bilateral posterior lenticonus in the mother. Biomicroscopy confirmed that each sibling had bilateral posterior len- ticonus that was more easily diagnosed in the brother. Uneventful phacoemulsifi- cation was performed in each eye with a foldable acrylic posterior chamber intraocular lens (IOL) placed vertically within the capsular bag in 3 eyes and hori- zontally in 1 eye. On the day after surgery, biomicroscopy revealed vertical wrin- kles limited to the central 2.0 mm of the posterior capsule corresponding to the cone in the eyes in which the IOLs had been vertically placed. We hypothesize that these striae occurred within the cone as a result of redistributing the usual mechanical forces associated with capsule stretch between the most distal con- tact points of the haptics. We believe that the appearance of these multiple striae limited to the central posterior capsule represents an unreported postoperative finding associated with posterior lenticonus. J Cataract Refract Surg 2003; 29:2029 –2031 © 2003 ASCRS and ESCRS P osterior lenticonus or lentiglobus is a well-circum- scribed, round or oval protuberance of the posterior lens capsule that is restricted to a 2.0 to 7.0 mm axial area. It may be diagnosed in infancy, and the posterior bulge may increase with age. Complicated cataract is often associated with this anomaly, although severe dis- tortion through a clear lens alone may be an indication for surgical intervention. 1 We report a postoperative finding involving the posterior capsule in 2 siblings with bilateral posterior lenticonus who had cataract surgery. Case Report Case 1 A 15-year-old teenager presented with a history of diffi- culty reading fine print and identifying letters on the black- board. He was also bothered by glare on bright days. Family history was positive for bilateral posterior lenticonus in the mother, who had had successful phacoemulsification with posterior chamber intraocular lens (IOL) implantation by 1 of us (R.H.O.) more than a decade before. The patient had congenital hearing loss. On examination, the best corrected visual acuity mea- sured 20/25 with -0.25 sphere in the right eye and 20/25 with +0.25 +0.25  15 in the left eye. Glare reduced the acuity to 20/40 in each eye. Biomicroscopy of the anterior segment revealed transparent lenses with a subtle but definite posterior oval protuberance in each eye. The slit beam from the Hruby lens was markedly distorted when it passed across the retina, and the red reflex with the direct ophthalmoscope produced a central, dark, oil-droplet appearance, confirming the diagnosis of posterior lenticonus in both eyes. The remain- der of the examination was unremarkable. The patient had uneventful phacoemulsification with implantation of a foldable 3-piece acrylic MA50BM IOL (Al- con) placed vertically in the capsular bag in each eye. The procedures were 4 months apart. On the day after each sur- Accepted for publication March 4, 2003. From the Cincinnati Eye Institute (Osher, F. Marques, D. Marques, Cionni) and the Department of Ophthalmology, University of Cincin- nati College of Medicine (Osher), Cincinnati, Ohio, USA, and the Department of Opthalmology, Faculdade de Medicina do ABC (F. Marques, D. Marques), Sa ˜o Paulo, Brazil. Drs. Osher and Cionni are consultants to Alcon. None of the other authors has a financial or proprietary interest in any material or method mentioned. Correspondence to Robert H. Osher, MD, Cincinnati Eye Institute, 10494 Montgomery Road, Cincinnati, Ohio 45242, USA. © 2003 ASCRS and ESCRS 0886-3350/03/$–see front matter Published by Elsevier Inc. doi:10.1016/S0886-3350(03)00237-2