Journal of Clinical and Experimental Ophthalmology

Journal of Clinical and Experimental Ophthalmology
Open Access

ISSN: 2155-9570

Case Series - (2015) Volume 6, Issue 2

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Anterior-Posterior Lens Capsular Phimosis in a Pseudophakic Patient

Asaf Achiron1,2*, Fady Haddad1,2 and Uri Hamiel2
1Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel
2Sackler School of Medicine, Tel-Aviv University, Israel
*Corresponding Author: Asaf Achiron, Department of Ophthalmology, The Edith Wolfson Medical Center, 62 Halochamim St., Holon, Israel, Tel: +972-3-5028706, Fax: +972-3-5028703 Email:

Case Report

During a routine cataract surgery the anterior portion of the lens capsule is opened and the cataract is removed. The intraocular lens (IOL) is then inserted into the remaining portion of the capsule, which holds the IOL in position. In cases in which the capsule is incapable of holding the IOL (a capsular tear or zonular instability) or in cases where the IOL cannot be inserted into the capsule due to a small anterior capsulorhexis the IOL is implanted in an alternative location: either the ciliary sulcus, or the anterior chamber.

Posterior capsular opacification is the most frequent complication after cataract removal surgery due to epithelial cells migration [1]. Here we present a unique pattern of such capsular opacification due to adhesion between the anterior and posterior lens capsule.

A 76 year-old female with a history of acute angle closure glaucoma underwent a cataract surgery. The eye had a short axial length (22.3 mm) with posterior synechiae and a 4.5 mm dilated pupil diameter. Due to this anatomy a small capsulorhexis was performed, rendering the implantation of the IOL into to the capsule impossible. Therefore, the IOL was inserted in the sulcus, in front of the anterior lens capsule, leaving the capsule empty. With no IOL to act as a barrier inside the lens capsule, epithelial cells migrated and proliferated over both anterior and posterior capsules, leading to central fibrous adhesion and capsular shrinkage (Figure 1).

clinical-experimental-ophthalmology-Capsular-phimosis

Figure 1: Capsular phimosis may occur following in-bag implantation.

Capsular phimosis may occur following in-bag implantation of IOLs. It typically occurs in patients with pseudoexfoliation, diabetic retinopathy, myotonic dystrophy, retinitis pigmentosa, uveitis, Marfan’s syndrome, high myopia or other factors associated with weakened zonules [2,3]. It results in reduction and distortion of the anterior capsular opening. As in our patient, the effect of phimosis is thought to be more prominent when the capsularhexis is small [4].

Preventing the development of capsular phimosis might be achieved by Capsular tension rings, capsule-bending rings, large capsulorhexis (between 5.5 and 6mm), using a three-piece IOL, making radial relaxing incisions in the anterior lens capsule and thorough cortical cleanup [4-6].

References

  1. Moreno-Montañés J, Sánchez-Tocino H, Rodriguez-Conde R (2002) Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation. J Cataract Refract Surg 28: 717-719.
  2. Sudhir RR, Rao SK (2001) Capsulorhexisphimosis in retinitis pigmentosa despite capsular tension ring implantation. J Cataract Refract Surg 27: 1691-1694.
  3. Cheour M, Brour J, Boukari M, Kraiem A (2010) Capsulorhexis contraction syndrome despite capsular tension ring implantation. Bull SocBelgeOphtalmol : 19-21.
  4. Epstein RH, Liu ET, Werner L, Kohnen T, Kaproth OK, et al. (2014) Capsulorhexisphimosis with anterior flexing of an accommodating IOL: case report and histopathological analyses. J Cataract Refract Surg 40: 148-152.
  5. Al-Kharashi SA, Al-Obailan M (2009) Capsular phimosis with complete occlusion of the anterior capsular opening after intact continuous curvilinear capsulorrhexis. Saudi journal of ophthalmology:Official journal of the Saudi Ophthalmological Society. 23: 175-178.
  6. Edrich CL, Ghanchi F, Calvert R (2005) Anterior capsular phimosis with complete occlusion of the capsulorhexis opening. Eye (Lond) 19: 1229-1232.
Citation: Achiron A, Haddad F and Hamiel u (2015) Anterior-Posterior Lens Capsular Phimosis in a Pseudophakic Patient . J Clin Exp Ophthalmol 6:428.

Copyright: © 2014 Achiron A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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