Anterior Capsular Contraction Research Articles

Anterior Capsular Phimosis Following Cataract Surgery in a Patient with Pseudoexfoliation Syndrome

Pseudoexfoliations syndrome increases the risk of anterior capsular contraction syndrome. An 74-year-old man with pseudoexfoliation syndrome underwent cataract surgery in the right eye at Mohamed V military hospital, Morocco. The surgical procedure was uncomplicated, and the IOL was implanted in the capsular bag. One month after surgery, visual acuity was 20/20 (Snellen). Two months after surgery, however, significant anterior capsule phimosis was noted, with nasal zonular stretching and temporal displacement of the lens. The patient was satisfied with her visual acuity, and no further procedures were necessary. The patient is periodically reassessed.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches.

Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.

The first experience of using femtosecond laser in the treatment of anterior capsular contraction syndrome

The study was performed to develop a femtosecond laser-assisted technique for anterior capsulotomy in anterior capsular contraction syndrome and assess its preliminary results in preventing the progression of pathological changes in the capsular bag. The examination and femtosecond laser-assisted treatment without additional surgical intervention was performed in 6 patients (6 eyes) aged 69 to 73 years with anterior capsular contraction syndrome. Femtosecond laser-assisted anterior capsulotomy was performed using the VICTUS system (Technolas Perfect Vision, Germany). Capsulotomy diameter was 4.0-4.5 mm, laser radiation energy - 9000 nJ, laser exposure depth 900-1000 μm. The diameter of the anterior capsulotomy before treatment was 2.85 mm [2.75; 2.93]. After 1 month, the diameter of the anterior capsular opening was 2.88 mm [2.78; 2.96] (p>0.05). One year after femtosecond laser intervention, the anterior capsulotomy opening was almost the same shape and diameter - 2.84 mm [2.74; 2.94] (p>0.05). Femtosecond laser-assisted circular capsulotomy is an effective and safe method for preventing the progression of anterior capsular contraction syndrome in the absence of severe IOL decentration and for maintaining the diameter of the anterior capsular opening of at least 2.5-3.0 mm.

Complete resolution of hyperopic shift in anterior capsular contraction syndrome after Nd:YAG laser capsulotomy: a case report

Link of Video Abstract: https://youtu.be/UfCbUNzPIRE Background: Anterior capsular contraction syndrome (ACCS) is a disorder in which the anterior capsulectomy opening shrinks excessively. One of the many factors that have been discovered to aggravate the problem is a lack of zonular support for the lens capsule. The prognosis for non-progression of contractions after Nd:YAG anterior capsulotomy is quite excellent. This study aims to present a complete resolution of the hyperopic shift in an anterior capsular contraction syndrome (ACCS), a rare complication of cataract surgery. Case Illustration: This case report presented a 63-year-old female who developed ACCS in the right eye two years after uncomplicated cataract surgery and intraocular lens implantation. A moderate hyperopic shift of +3.00 D was noted in the affected eye at the initial presentation. Slit-lamp examination revealed an anterior capsule opacification and anterior capsular contraction with fibrosis surrounding the capsulorhexis opening. Ocular and systemic past medical history was unremarkable, and no known risk factors associated with contraction syndrome were found. Nd:YAG laser capsulotomy with six relaxing incisions was performed to release the anterior capsular contraction. Two weeks following capsulotomy, the patient’s visual acuity remarkably improved to LogMAR 0.00 without correction. The hyperopia was completely resolved, and a decrease in anterior chamber depth compared to pre-capsulotomy measurement was noted. ACCS is a possible complication following capsulorrhexis performed in uneventful cataract surgery, which may occur in patients with no known ocular or systemic risk factors. ACCS is commonly asymptomatic, and hyperopic shift is a rare manifestation of ACCS. The backward shift of the intraocular lens (IOL) induces hyperopia due to the anterior capsule contraction. The preferred treatment for ACCS is relaxing incisions using Nd:YAG laser capsulotomy. Conclusion: Hyperopic shift in ACCS is a rare complication of cataract surgery. However, prompt treatment of contraction release with Nd:YAG laser capsulotomy effectively restored visual function.

Influence of IOL Weight on Long-Term IOL Stability in Highly Myopic Eyes.

PurposeThis study aimed to investigate the influence of intraocular lens (IOL) weight on long-term IOL stability in highly myopic eyes.Materials and MethodsA total of 205 highly myopic cataract eyes of 205 patients implanted with the MC X11 ASP (Group A, 86 eyes) or 920H IOL (Group B, 119 eyes) were included in this retrospective study. Eyes were divided into 3 subgroups according to the IOL power: low (≥-5 to <5 D), medium (≥5 to <14 D), and high (≥14 D) IOL power. At 3 years after surgery, IOL decentration and tilt, high-order aberrations, and anterior capsular opening (ACO) area were measured. The influence of IOL weight on long-term IOL stability was evaluated.ResultsGroup B had a significantly greater IOL weight than Group A (Group B vs. Group A: 28.31 ± 2.01 mg vs. 25.71 ± 4.62 mg, P < 0.001). Correspondingly, Group B presented significantly greater overall and inferior decentration than Group A, especially for low and medium IOL power (all P < 0.05). In both groups, overall and vertical decentration was significantly correlated with IOL weight (all P < 0.05). Group B showed a significantly greater ACO area than Group A (P < 0.05). Multivariate analysis showed that decentration in Group A was affected by IOL weight, while decentration in Group B was affected by IOL weight and AL.ConclusionsHigher IOL weight may lead to greater long-term IOL decentration in highly myopic eyes, while the haptic design may play a role in anterior capsular contraction.

Anterior capsular contraction syndrome with hyperopic shift

PurposeTo present a case of anterior capsular contraction syndrome with hyperopic shift two weeks after an uncomplicated combined cataract surgery and pars plana vitrectomy. ObservationsA 55-year-old man, with no known risk factors, who developed anterior capsular contraction syndrome with hyperopic shift two weeks after an uncomplicated combined cataract surgery and pars plana vitrectomy. Hyperopic shift was caused by posterior displacement of the intraocular lens with anterior flexion of the haptics. Manual peeling of the anterior capsule using the can-opener approach and microscissors successfully restored vision and corrected refractive errors. Conclusions and ImportanceAnterior capsular contraction syndrome is a complication of cataract surgery and is known to be affected by zonular weakness, pre-existing systemic and ocular conditions, intraocular lens materials, and intraoperative complications. Careful maneuver with surgery or laser can effectively restore vision and correct refraction.

Complete anterior capsule phimosis after routine cataract surgery

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.

Динамические показатели УБМ при переднем капсулярном контракционном синдроме

The article presents the results of UBM studies of patients with anterior capsular contraction syndrome (CS). Purpose. Тo use the UBM method to study the state of the ciliary body (CB) and the capsular bag of the lens in patients with CS. Material and methods. The study included 42 patients with capsular CS. The UBM HI-scan ultrasound biomicroscope (Optikon, Italy) was used. Results. The reduction of the capsule bag of the lens was accompanied by a significant decrease in the diameter of the anterior capsulotomy opening, IOL decentration and its displacement towards the posterior pole of the eye, stretching or damage to the zonula ciliaris, and an increase in the CB thickness. In 2 cases, ruptures of the CB and its separation from the place of attachment to the radix iridis were recorded. Conclusion. UBM is an effective assessment method for CS, which allows us to study the state of the capsule bag of the lens and CB, evaluate the effectiveness of laser treatment and predict the risks associated with a high probability of complications. Key words: capsular contraction syndrome, anterior capsule, lens, laser, UBM, ciliary body.

Role of ultrasound biomicroscopy in assessing the results of laser treatment in capsular contraction syndrome

The article presents the results of ultrasound biomicroscopy (UBM) measurements of pseudophakic patients with anterior capsular contraction syndrome (CS).To analyze the results of UBM in capsular CS before and after laser treatment.The study included 42 patients with capsular CS. The HI-scan ultrasound biomicroscope (Optikon, Italy) with 35 MHz UBM probe and the LPULSA SYL-9000 Premio laser (LightMed, Taiwan-USA) were used.The shrinkage of the capsular bag of the lens was accompanied by a significant decrease in the diameter of the anterior capsulotomy opening, IOL decentration and its displacement towards the posterior pole of the eye, stretching or damage to the ciliary zonule, and an increase in the ciliary body thickness. In 2 cases, ruptures of the ciliary body and its separation from the place of attachment to the iris root were observed. The optimal algorithm of laser treatment was developed to minimize the risk associated with possible aggravation of the clinical manifestations of CS and possible complications during laser treatment.UBM is an effective examination method for CS, which allows assessing the state of the capsular bag of the lens and the ciliary body, evaluating the effectiveness of laser treatment and predicting the risks associated with a high probability of complications.В статье представлены результаты проведения ультразвуковой биомикроскопии (УБМ) при переднем капсулярном контракционном синдроме (КС) у пациентов с артифакией.Анализ показателей УБМ при капсулярном КС до и после лазерного лечения.В исследование включены 42 пациента с капсулярным КС. В работе использовали ультразвуковой сканер UBM HI-scan (Optikon, Италия) с датчиком для УБМ (35 МГц); лазерную офтальмологическую установку LPULSA SYL-9000 Premio (LightMed, Тайвань — США).Сокращение капсульной сумки хрусталика при КС сопровождается значительным уменьшением диаметра переднего капсулотомического отверстия, децентрацией интраокулярной линзы и ее смещением в сторону заднего полюса глаза, растяжением или повреждением ресничного пояска, увеличением толщины цилиарного тела (ЦТ). В двух случаях зафиксированы разрывы ЦТ и его отрыв от места прикрепления к корню радужки. Разработан оптимальный алгоритм лазерного лечения, позволяющий минимизировать риск, связанный с возможным усугублением клинических проявлений КС и вероятными осложнениями во время лазерного вмешательства.УБМ является эффективным методом объективной оценки состояния структур переднего сегмента глаза при КС, позволяющим определять эффективность проводимого лазерного лечения и прогнозировать возможные риски развития осложнений.

Методика хирургической профилактики капсулярного контракционного синдрома в ходе факоэмульсификации

Методика хирургической профилактики капсулярного контракционного синдрома в ходе факоэмульсификации

Commentary: Anterior capsule polishing: The present perspective.

Commentary: Anterior capsule polishing: The present perspective.

Differentiated method of surgical prophylaxis against anterior capsular contraction syndrome during phacoemulsification

To develop and clinically evaluate a differentiated method of surgical prophylaxis against ACCS during PE in patients with lens subluxation. Phacoemulsification surgery with in-the-bag IOL implantation and postoperative follow-up were carried out in 192 patients (192 eyes) with cataract and lens subluxation. In all patients, complete anterior capsulorhexis at the beginning of the surgery was not possible. A differentiated approach was used for capsulorhexis extension at the final stage of the operation after in-the-bag IOL implantation. Three groups of patients were formed according to the three most common clinical situations. There were no signs of ACCS development in as many as 189 (98.4%) cases. In 3 (1.6%) cases, slight narrowing of the anterior capsulorhexis opening was noted, however, with no effect to the IOL position and functional results of the operation. The differentiated approach to anterior capsulorhexis in patients with lens subluxation allowed to perform phacoemulsification with in-the-bag IOL implantation and to avoid ACCS development in the late postoperative period.

Application of femtosecond laser technology in the management of subluxated lens

To evaluate the application of femtosecond laser technology in the management of subluxated lens. We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients' eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed. We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03%) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation (P &lt; 0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90%) showed slight tilt of the IOLs, and 3 eyes (10.34%) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87%), incomplete capsulotomy (17.24%) and contracted pupils (13.79%). The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients' visual function.

Circular YAG laser anterior capsulotomy for anterior capsule contraction syndrome.

To evaluate circular neodymium: YAG laser incision in cases of anterior capsular contraction syndrome (ACCS) by comparing it to radial Neodymium: YAG laser incision as for efficacy and safety. Ophthalmology Department, Benha University Hospitals. The study was done on 74 eyes of 66 patients with symptomatic ACCS. Eyes were randomly allocated to one of the two groups. Group I were treated by circular YAG laser anterior capsulotomy. Group II were treated by radial YAG laser anterior capsulotomy. All cases passed a full ophthalmic examination before laser capsulotomy, 1week, 1month, 6months and 12months after laser. BCVA at the 1st week and the 1st month after the capsulotomy did not show any significant difference between the two groups; however at the 3rd and 6th months, the circular group showed better visual acuity than the radial group (p 0.001 and < 0.001, respectively). All post-YAG UCVA and BCVA were significantly higher than pre-YAG UCVA and BCVA in both groups. IOL decentration occurred in two cases in radial group. Circular group had significantly higher percentage of contraction relief (94.4%) than the radial group (66.7%) with p value 0.003. Circular Nd:YAG anterior capsulotomy is more effective and safe than radial capsulotomy in 1-year follow-up.

Morphologic Versions of Postoperative Opacities of the Lens Capsule in Contemporary Cataract Surgery (Working Classification)

Purpose: creation of working classification of morphologic variations of postoperative lens capsule opacity after Micro-Invasive cataract surgery. Material and methods. Morphologic study of the lens capsule (LC) has been conducted on 4 artiphakic cadaveric eyes. A specimen of an isolated anterior lens capsule, obtained during the repeated operation with changes characteristic for anterior capsular contraction syndrome has been studied too. The obtained specimens have been researched with the method of semithin sections. Results. The analysis of the morphologic cadaveric LC specimens revealed the polymorphism of secondary cataract (SC). Besides well known “classic” SC forms, which were caused by fibroplasias processes or pseudo-regeneration a new type of postoperative LC opacity not represented in the available literature before has been revealed. The given variant of opacities was called “pseudo-hyaloid” form and characterized by the absence of clear LC borders, changes of its normal structure, the appearance of loose fibrillar structure with microslit spaces and exfoliations, that possibly was the consequence of acustic cavitation, arising in the result of ultrasonic effect. As a result the LC lost characteristic for it the role of the dense bed and made impossible adhesion and migration on its changed surface the proliferative fibrocellular elements characteristic for “classic” SC forms. The microscopy results of the isolated anterior LC specimen in the area of capsulotomic aperture showed the presence of altered abundant loose fibrillar tissue with microporous structure and expressed forming of folds. Making layers of fibrous tissue exceeded the thickness of the normal anterior LC in 10 and more times and considerably reduced the diameter of capsulotomic aperture. Conclusion. The variety of postoperative LC opacities confirmed by the results of morphologic studies afforded to suggest a new working classification in which all possible morphologic variants and the stages of the secondary pathologic changes forming of anterior LC. The suggested classification is convenient for the understanding and must promote to make a right algorithm in the choice of optimal and safe technology of laser reconstructive interventions.

Evaluation of anterior capsular contraction syndrome after cataract surgery with commonly used intraocular lenses.

PurposeThe purpose of this study was to compare the incidence of anterior capsular contraction syndrome (ACCS) in cataract patients after implantation with one of two most commonly used hydrophobic acrylic lenses.SettingThis study included patients from Loma Linda University, Loma Linda, CA, USA.DesignThis study is a retrospective chart review.MethodsIn this study, 1,047 eyes of 811 patients with and without known ACCS risk factors who underwent successful phacoemulsification and intraocular lens (IOL) implantation were included. Eyes that sustained intraoperative capsular tears and patients with a postoperative follow-up of <1 month were excluded. Each patient underwent surgery by the same surgeon receiving either the SN60WF IOL or the ZCB00 IOL. The duration of postoperative follow-up along with the presence of ACCS and the dimensions of the anterior capsule opening in these cases were recorded. The incidence of ACCS between the two lenses was compared.ResultsACCS was significantly (P=0.045) less frequent in those patients who received the ZCB00 lens compared to those who received the SN60WF lens, despite a significantly greater (P<0.0001) number of patients with ACCS risk factors in the ZCB00 cohort.ConclusionIn a direct comparison of the ZCB00 and SN60WF IOLs, a lower incidence of ACCS was found with ZCB00 IOL.

Operacija sive mrene pri bolnikih s sladkorno boleznijo

Ophthalmic complications of diabetes are one of the leading causes of visual loss and blindness in the working population worldwide. Globally, an estimated 422 million adults were living with diabetes in 2014. According to the World Health Organisation, this number will rise to an estimated 592 million by 2035. Cataract is a clouding of the eye lens. Surgery is indicated when cataract causes significant visual impairment. Several clinical studies have shown that cataract development occurs more frequently and at an earlier age in diabetic compared to nondiabetic patients. Cataract surgery is the most frequent ophthalmic surgical procedure and has an excellent outcome. However, diabetic patients may have more complications and a poor visual outcome. They are prone to ocular surface disease, intraoperative complications, corneal oedema in the early postoperative period and an increased incidence of cystoid macular oedema in patients with retinopathy. Anterior capsular contraction is also more frequent. A good prognosis is expected in patients with good systemic and ophthalmological preoperative, operative and postoperative management.

Combined YAG-laser capsulotomy in pseudophakic patients with anterior capsular contraction syndrome

to develop a safe technique of combined laser anterior capsulotomy (LAC) in patients with ACCS. The study included 19 patients (20 eyes) with ACCS. The suggested LAC technique involved two differently directed YAG-laser cuts that could be regarded as a combination of radial anterior capsulotomy and anterior peripheral linear capsulotomy. With the cuts located perpendicularly to each other, the distal end of each radial cut was connected to the middle of each longitudinal cut. The suggested technique allows an increase in the anterior capsulorhexis diameter up to more than twice the pre-laser size. The difference between the average pre- and post-laser capsulorhexis diameters was statistically significant (р<0.0001). Neither case developed an unpredictable anterior capsule tear. The safety of the new technique is ensured by preliminary longitudinal cuts that create a barrier against unpredictable radial tears in the capsular bag during radial capsulotomy.

Clinical presentation and management of anterior capsular contraction

Purpose: Aim of this study is to analyze clinical presentation and predisposing risk factors of anterior capsular contraction following phacoemulsification and to assess challenges encountered in management. Methods: This is retrospective study of anterior capsular contractions of capsulorhexis following phacoemulsification. All patients were analyzed for clinical presentation by detail history and slit lamp examination. YAG laser capsulotomy or surgical excision of phimosis was done and various challenges encountered in management were detailed. Results: Total 20 patients (23 eyes), age between 26 years 72 years,, with 13 male and female 7 were analyzed retrospectively. The predisposing risk factors noted were Uveitis (7 patients), myopia (3 patients), pseudo exfoliation (2 patients), diabetes (3 patients), trauma (1 patient), both diabetes and uveitis (1patient), Status post phacovitrectomy (1 patient) and no accompaniments in (2 patients). We managed 18 patients (21 eyes) by observation in (3 eyes), YAG laser in (7 eyes), simple surgical excisions in (8 eyes), excision with vitrector (1 eye), aspiration of milky fluid behind IOL from bag (1 eye) and phimosed dislocated bag removal from anterior chamber and intraocular lens (IOL) exchange with (SF) scleral fixated IOL (1eye). Conclusions: Anterior capsular contraction is more common with patients with various risk factors and has varied clinical presentations. Simple procedures like YAG and surgical excision will help patients to restore vision.

In-the-bag decentration of an intraocular lens in a patient with a tendency to hypertrophic scarring

We report a case of rapid anterior lens capsular contraction leading to decentration of a hydrophilic acrylic lens with stiff haptics (Rayner design). To our knowledge, this is the first report to investigate early capsular contraction with folding of the haptic over the optic in a patient with a tendency toward hypertrophic scar formation.