Surgical identification of posterior lenticonus

A 79-year-old patient was referred for cataract and high myopia. His optometrist noted difficult refraction. Biometry predicted an emmetropic intraocular lens power of +22.0 diopters. During cataract extraction, the typical features of posterior lenticonus were noted. A careful look for posterior lenticonus is suggested in cases in which there is a discrepancy between the biometry and refraction and no significant nuclear sclerosis to account for the high myopia. Surgeons should be aware of dehiscence or thinning of the posterior capsule while doing cataract extraction in these patients.