a hypermature cataract , or morgagnian cataract , is an end stage in the process of age - related cataract formation . this condition leads to numerous potentially blinding conditions , including lens - induced uveitis , acute phacomorphic glaucoma , and phacolytic glaucoma . spontaneous lens dislocation into the vitreous cavity13 and absorption of the lens material4,5 have been described as complications of hypermature cataracts . we report a case of spontaneous rupture of the anterior lens capsule in a middle - aged woman with hypermature cataracts , who presented to us with nucleus dislocations in the anterior chambers of both eyes . it is important to highlight this rare presentation because it may lead to potential errors in identifying causes of nucleus dislocation , especially when a history of trauma is absent . a 52-year - old malay woman who was a known case of thyrotoxicosis presented with vision that had been poor in both eyes for 5 years and that was worsening in severity . she was the first - born child of nonconsanguineous parents , in a family of five . on examination , the visual acuity in both eyes was 6/60 . the nuclei were small , and each had dislocated into the anterior chamber of the respective eye . calcification spots in the capsular tags were clearly visible in the pupillary margins , suggesting they were from ruptured , hypermature cataracts in both eyes , which had resulted in anterior dislocation of each nucleus ( figure 1 ) . there was no lenticular - corneal touch noted , nor was any pseudoexfoliative material at the pupillary margins observed . the fundus was not visible , as she had poorly dilating pupils in both eyes . she was of normal stature , cardiovascular and skeletal assessments were normal , and hearing test results were normal . the patient was advised to have intracapsular cataract and intraocular lens implantations in both eyes , however she refused , and defaulted on her follow - up . despite numerous health awareness strategies and campaigns , hypermature cataracts are still frequently seen in malaysia . based on our experience , patients refusal of modern ophthalmic treatment is the main reason , especially when their fellow eye is seeing well . in a hypermature cataract , the milky fluid from the cortical matter flows into the anterior chamber through a minute break in the lens capsule , resulting in anterior uveitis and phacolytic glaucoma . in contrast , a minute break in the posterior capsule may result in gradual absorption of lens matter without complications . this leaves a hard , shrunken nucleus which may cause the spontaneous dislocation of the lens , especially into the vitreous cavity , and this is attributable to weak zonules.13 spontaneous rupture of the lens capsule in a hypermature cataract is extremely uncommon.6,7 based on a pubmed search , we noted a similar case was reported by ming in 1963.7 ming described the expulsion of the nucleus following rupture of an anterior capsule in a 50-year - old woman who had a hypermature cataract in the left eye , and ming attributed her poor final visual acuity to an unknown cause of optic atrophy.7 our patient presented with bilateral anterior dislocations of both lenses nuclei . the presence of multiple calcified spots was indicated by the lens - capsule remnants visible at each eye s pupillary edge . this suggested that hypermature cataracts were the most likely cause of our patient s ruptured anterior lens capsules . we postulated that the cortical matter had probably been absorbed much earlier or that there had been a posterior leak into the vitreous cavity . our patient was asymptomatic , and did not show sign of lens - induced uveitis or increased intraocular pressure . we were unable to assess her optic nerve and retinal status due to poor pupillary dilation in both eyes . it is quite alarming that our patient , a 52-year - old woman , had developed hypermature cataracts in both eyes . spontaneous rupture of anterior lens capsules have also been described in younger patients with chronic uveitis,8 polar cataract,9,10 and other systemic illnesses , such as alport syndrome1113 and marshall syndrome.14 a complete systemic assessment and genetic work - up are essential when a systemic disease is suspected , especially when nephritis ( in alport syndrome ) and connective tissue disease ( in marshall syndrome ) are encountered . a spontaneous rupture of the anterior capsule is sometimes misleading when it occurs in younger and pre - senile age groups . spontaneous rupture of the anterior lens capsule that leads to anterior dislocation of the nucleus is a rare complication of hypermature cataracts . patients negligence and refusal to accept modern treatment remain the sole reasons for this avoidable condition in our patients .
hypermature cataracts are commonly seen in developing countries . spontaneous rupture of the anterior capsule , resulting in dislocation of the lens nucleus into the anterior chamber , presents rarely in hypermature cataracts . 
 we describe a middle - aged woman who presented with spontaneous anterior dislocation of the nucleus in both eyes . 
 the presence of calcification spots in the posterior capsule at the pupillary edge strongly suggested that our patient had hypermature cataracts . 
 it is important to highlight this uncommon cause of nucleus dislocation in a patient with no previous history of ocular trauma .