During a routine cataract surgery
the anterior portion of the lens capsule is opened and the cataract is removed. The intraocular lens (IOL) is then inserted into the remaining portion of the capsule, which holds the IOL in position. In cases in which the capsule is incapable of holding the IOL (a capsular tear or zonular instability) or in cases where the IOL cannot be inserted into the capsule due to a small anterior
capsulorhexis the IOL is implanted in an alternative location
: either the ciliary sulcus, or the anterior chamber.
Posterior capsular opacification is the most frequent complication after cataract removal surgery due to epithelial cells migration [1
]. Here we present a unique pattern of such capsular opacification due to adhesion between the anterior and posterior lens
A 76 year-old female with a history of acute angle closure glaucoma
underwent a cataract surgery. The eye had a short axial length (22.3 mm) with posterior
synechiae and a 4.5 mm dilated pupil diameter. Due to this anatomy a small capsulorhexis was performed, rendering the implantation of the IOL into to the capsule
impossible. Therefore, the IOL was inserted in the sulcus, in front of the anterior lens capsule, leaving the capsule empty. With no IOL to act as a barrier inside the lens capsule, epithelial
cells migrated and proliferated over both anterior and posterior capsules, leading to central fibrous
adhesion and capsular shrinkage (Figure 1).
Capsular phimosis may occur following in-bag implantation of IOLs. It typically occurs in patients with pseudoexfoliation, diabetic retinopathy, myotonic dystrophy, retinitis pigmentosa, uveitis, Marfan’s syndrome, high myopia or other factors associated with weakened zonules [2
]. It results in reduction and distortion of the anterior capsular opening. As in our patient, the effect of phimosis is thought to be more prominent when the capsularhexis is small [4
Preventing the development of capsular phimosis might be achieved by Capsular tension rings, capsule-bending rings, large capsulorhexis (between 5.5 and 6 mm), using a three-piece IOL, making radial relaxing incisions in the anterior lens capsule and thorough cortical cleanup [4