Capsular Phimosis Syndrome
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
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
