Bilateral zonular dehiscence during cataract surgery in a patient with systemic sclerosis

Systemic sclerosis, also known as scleroderma, is a rare and chronic autoimmune connective disorder that affects most organs. While clinical findings of scleroderma patients in the context of the eye have been described to include lid fibrosis and glaucoma, almost nothing has been reported regarding ophthalmologic surgical complications in scleroderma patients.

Here, we report bilateral zonular dehiscence and iris prolapse during two independent cataract extractions performed by separate experienced anterior segment surgeons in a patient with known systemic sclerosis. The patient did not have any other known risk factors for these complications to occur.

In our patient, bilateral zonular dehiscence raised the possibility of poor connective tissue support secondary to scleroderma. We recommend that clinicians are aware of potential complications in performing anterior segment surgery in patients with known or suspected scleroderma.