Anterior Capsular Fibrosis & Phimosis

• Capsular fibrosis is associated with clouding of the anterior capsule

• If a substantial portion of the IOL optic is covered by the opaque anterior capsule, including portions exposed through the undilated pupil, the patient may experience symptoms such as glare— especially at night because of physiologic mydriasis in darkness—or a perception that their vision has become cloudy or hazy

• Capsular phimosis describes the postoperative contraction of the anterior capsule opening because of circumferential fibrosis

• Phimosis produces symptoms similar to and often more pronounced than fibrosis alone

• Fibrosis and anterior capsule contraction occur more frequently with smaller capsulorrhexis openings, under lying pseudoexfoliation syndrome, and abnormal or asymmetric zonular support (eg, penetrating or blunt trauma, Marfan syndrome, or surgical trauma)

• Anterior capsule contraction may contribute to late pseudophacodonesis or in-the- bag IOL subluxation due to stress on the zonular apparatus

• Anterior capsule contraction, can be reduced with anterior capsule polishing to remove residual lens epithelial cells

• Capsular phimosis is treated with several radial Nd:YAG laser anterior capsulotomies to release the annular contraction, reduce the traction on the zonule, and enlarge the anterior capsule opening

• It is performed similarly to Nd:YAG caps, with care taken to not defocus too far posteriorly and damage the under lying IOL with laser pitting

• Anterior capsule tissue or a fibrotic ring is tougher and thus requires more laser power than the posterior capsule

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Image from Rajan Eye Care Hospital

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