Spontaneous idiopathic true exfoliation of the anterior lens capsule during capsulorhexis.

We report a unique case of spontaneous per-operative idiopathic development of true exfoliation of the anterior lens capsule during capsulorhexis. A 45 year old female who underwent phacoemulsification for a cataract in the left eye, developed a partial split (the double ring sign) and eventual complete separation of the superficial lamina of the lens capsule during capsulorhexis. Radial tears developed in the remaining lamina making the capsular bag unstable. The surgery was converted to manual nucleus expression. An intra ocular lens was implanted via scleral fixation. The final best corrected visual acuity in the left eye was 6/6. The patient is comfortable with the vision. Though a rare event, the surgeon must always be alert to the development of spontaneous idiopathic per operative true exfoliation of the lens capsule.