Hypermature cataract is characterized by which feature?

• A. Mature cataract with complete opacification
• B. Wrinkling of the anterior lens capsule causing a deeper anterior chamber
• C. Liquified cortex with sinking nucleus
• D. Partial lens opacification with preserved red reflex

Answer: (B)

Hypermature cataract involves extreme dehydration of the lens with rupture and shrinkage of its contents. This leads to wrinkling of the anterior lens capsule as it contracts, a visible sign on exam. The shrinking lens also tends to deepen the anterior chamber because the lens volume decreases and the iris–lens diaphragm moves, making AC depth appear greater. This combination—wrinkled anterior capsule plus deeper anterior chamber—is a classic feature of a hypermature cataract.

Other descriptions point to different stages or subtypes. A mature cataract has complete opacification without this capsule wrinkling; an immature cataract shows partial opacification with the red reflex still present; and a Morgagnian (a form of hypermature) cataract describes cortex liquefaction with the nucleus sinking, which is another phenomenon but not the single defining cue emphasized here.