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Journal of Clinical Images and Medical Case Reports

ISSN 2766-7820
Case Report - Open Access, Volume 2

Complete anterior capsule phimosis after routine cataract surgery

Aliénor Vienne Jumeau1,2*; Mikaël Guedj1,2

1 Institut Arthur Vernes, 36 rue d’Assas 75006, Paris

2 Université Paris Descartes, Paris

*Corresponding Author: Aliénor Vienne Jumeau
Institut Arthur Vernes, 36 rue d’Assas 75006, Paris.
Email: [email protected]

Received : Nov 22, 2021

Accepted : Jan 10, 2022

Published : Jan 17, 2022

Archived : www.jcimcr.org

Copyright : © Vienne Jumeau A (2022).

Citation: Vienne Jumeau A, Guedj M. Complete anterior capsule phimosis after routine cataract surgery. J Clin Images Med Case Rep. 2022; 3(1): 1576.

Clinical image description

A 79-year-old woman with pseudoexfoliation and zonular weakness underwent routine phacoemulsification with 5.5 mm capsulorhexis and implantation of posterior chamber intra-ocular hydrophobic lens (KSSPStaar®). Examination at one-week post-surgery was normal. One-month post-surgery, the vision had decreased to 20/200. Slit-lamp examination showed complete anterior capsular contraction syndrome with a thick central occluding membrane and decentered lens (Figure 1A). No inflammation of the anterior segment was noted. Because of the zonular weakness, YAG laser anterior capsulotomy was chosen rather than further intra-ocular surgery with scissors and cystotome. Radial impacts, performed as usual, failed to clear the thick central membrane, so we detach edit and let the operculum drop away from the visual axis (Figure 1B). This procedure allowed for visual clearance and 20/20 vision recovery.

Complete anterior capsule phimosis is a rare complication of cataract surgery [1-3]. Patients at risk of phimosis, such as those with pseudoexfoliation [4,5], inflammatory eye or diabetes, should be identified and cared for accordingly, to prevent full occlusion and perilous surgical or laser management. Some preventive measures include the choice of anintra-ocular lens with hydrophobic surfaces and performing a large enough capsulorhexis.

Figure 1A: Complete anterior capsule phimosis with thick occlusive membrane (*) and partially dislocated lens (arrow).

Figure 1B: Image after Nd: YAG laser capsulotomy: The membrane was detached and flapped down (*), leaving a clear visual axis and centered lens.

References

  1. Behrendt S, Wetzel W. Complete occlusion of the capsulorhexis incision by anterior capsule shrinkage. Ophthalmol Z Dtsch Ophthalmol Ges. 1994; 91: 526-528.
  2. Edrich CL, Ghanchi F, Calvert R. Anterior capsular phimosis with complete occlusion of the capsulorhexis opening. Eye Lond Engl. 2005; 19: 1229-1232.
  3. Spang KM, Rohrbach JM, Weidle EG. Complete occlusion of the anterior capsular opening after intact capsulorhexis: Clinicopathologic correlation. Am J Ophthalmol. 1999; 127: 343-345.
  4. Moreno Montañés J, Sánchez Tocino H, Rodriguez Conde R. Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation. J Cataract Refract Surg. 2002; 28: 717-719.
  5. Hayashi H, Hayashi K, Nakao F, Hayashi F. Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Br J Ophthalmol. 1998; 82: 1429-1432.