Capsular Phimosis/ Anterior capsular contraction syndrome ● Centripetal fibrosis and contraction of capsulorhexis after cataract surgery ● Can obstruct visual axis ● Secondary complications - Pseudophacodonesis, tilt of IOL, dislocation due to zonular weakness
Mechanism: Residual metaplastic lens epithelial cells (LEC) undergo mesenchymal transition and differentiation to fiber like cells → fibrous metaplasia and proliferation and outgrowth from anterior capsular margin → contraction towards centre→ shrinkage of capsulectomy opening and equatorial capsular bag diameter → imbalance between centrifugal and centripetal forces on the zonules → malposition of the capsulectomy opening, tilt of IOL, dislocation of IOL Risk Factors: Pre-existing: ● Pseudoexfoliation ● Uveitis/ chronic intraocular inflammation ● Retinitis pigmentosa ● Advanced age ● Diabetes ● High myopia etc. Surgical: ● Small capsulorhexis ● Inadequate removal of LECs ● Increased surgical trauma ● Type of IOL Prevention: ● Large capsulorhexis during surgery ● Complete cortical and LEC aspiration ● Anterior capsule Nd:Yag relaxing incisions right after surgery in patients with risk factors ● Reduction of post-operative inflammation Management: Minor cases: Nd: Yag laser anterior capsulotomy - radial nicks at 12,3,6 and 9 o’clock positions Severe cases: Manual surgical peeling of the fibrotic membrane www.ophthalmobytes.com Image from Rajan Eye Care Hospital #ophthalmology #ophthal #doctor #intraocularlens #capsulorhexis #cataractsurgery #phacoemulsification #ndyaglaser #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency
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