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A 76‐year‐old man underwent cataract surgery with implantation of an acrylic foldable intraocular lens by standard phacoemulsification technique. The preoperative and immediate postoperative period was uneventful. His postoperative visual acuity was 6/6.
However, 3 months later he gradually developed visual problems while doing close work or reading, although his distant visual acuity still remained 6/6.
He visited the eye casualty with the above complaints and the following slit‐lamp picture was noted.
What condition is seen in the picture (fig 11)) and what may have caused it?
Modern phacoemulsification cataract surgery involves injecting a pliable intraocular lens implant (IOL) with a total diameter 12.5 mm through a sub 3 mm incision. The IOL unfolds into the original lens capsule.
Although initially delighted with the result of his surgery, this patient noticed a progressive disturbance of his vision 3 months after surgery.
Anterior capsule contraction and a decrease in the anterior capsule opening size have been attributed to fibrous metaplasia of lens epithelial cells (LECs). These cells at the inner surface of the anterior capsule margin in contact with the IOL optic can produce a ring‐shaped fibrous membrane under the anterior capsule. A small anterior capsule opening at the time of surgery has been cited as the cause of severe anterior capsule shrinkage, and the ideal capsulorhexis size is proposed to be 5.5–6.0 mm or larger.1
Capsular phimosis is known to cause the following malpositions of intraocular lens:
The complication shown in the figure has not been published to the best of our knowledge but seems to have occurred due to the same condition.
Ocular conditions such as pseudoexfoliation syndrome,3 which can weaken ciliary zonular fibres, and chronic intraocular inflammation, such as pars planitis,3,4 have been associated with anterior capsule contraction. High myopia4,5 may be a factor. Medical conditions such as myotonic dystrophy3,5 and diabetes mellitus6 have also been associated. Lens design and lens material have also been found to play a role. In particular, silicone and PMMA intraocular lenses have been implicated for this condition7,8
The treatment options available for capsular phimosis may be:
In this case, the eye was reoperated on and the folded haptic trimmed. This did not cause instability of the IOL because of the firm capsular contracture around it.
Modern phacoemulsification cataract surgery involves injecting a pliable intraocular lens implant (IOL) with a total diameter 12.5 mm through a sub 3 mm incision. The IOL unfolds into the original lens capsule. Although initially delighted with the result of his surgery, this patient noticed a progressive disturbance of his vision 3 months after surgery. The supporting leg or haptic of the implant had folded over on itself as the capsule contracted around the IOL. The eye was operated on again and the folded haptic was trimmed. However, this did not destabilise the lens implant because it was firmly fixed in place by the contracted capsule around it. A follow up after 2 months showed good result.
Mr Paul Webzell and Mr Phillip Neely of the Medical Illustrations Department at Darlington Memorial Hospital, for helping out with preparing images for this submission.
Competing interests: None
Authors and guarantors: The corresponding author in this case has identified the condition and has passed the case to the consultant for management. The second author of this specialty images submission is also the guarantor. The guarantor had access to the data, and controlled the decision to publish