Contracted Capsule!

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⁣ ⁣⁣ ⁣ 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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