Capsular Contraction Syndrome 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.

ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

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.

A case report of different surgical methods for the treatment of retinitis pigmentosa complicated by capsular contraction syndrome after cataract surgery.

A case report of different surgical methods for the treatment of retinitis pigmentosa complicated by capsular contraction syndrome after cataract surgery.

Capsular Contraction Syndrome. Review. Methods of Prevention and Treatment. Part 2

The article describes the existing methods of preventing the occurrence and progression of capsule bag fibrosis. The types of used treatment are listed and structured. Key aspects of the principles of surgical treatment are highlighted. They are aimed to eliminate the dislocation of the IOL-fibrous capsular bag complex. Special attention is paid to the methods of suture and sutureless fixation of the IOL to the sclera or iris. The author’s techniques are given. Variants of fixing devices were used. The risks of possible complications were analyzed. Conclusion: capsular syndrome is an actual problem that requires attention and search for optimal treatment methods, depending on comprehensive assessment of the initial condition.

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.

Effect of lens capsular tension ring on preventing capsular contraction syndrome in the surgery of retinitis pigmentosa combined with cataract: Retrospective case series.

To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. Retrospective cases series study. Sixty-three cases (84 eyes) of RP with cataract were collected, including 30 males and 33 females. Phacoemulsification with 3.0mm clear corneal incision was performed in all the patients. IOL and CTR implantation were performed in 44 eyes, and IOL implantation alone was performed in 40 eyes. All cases were followed up at 1day, 1week and 1, 3, 6,12months after the surgery to compare the best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count (ECC) and complications before and after the surgery. All surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6months after surgery was 0.91±0.88 LogMAR, showing an improvement compared with the BCVA(1.3±0.7LogMAR) before surgery and there was a statistically significant difference (P=.003). Four cases of capsule contraction syndrome (CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was a statistically significant difference in the incidence of CCS between two groups (P=.047). Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is conducive to reducing the complications caused by capsule contraction.

Efficacy and complications of cataract surgery in high myopia.

To evaluate the efficacy and complications of cataract surgery in high myopia, a comprehensive search query was conducted from January 2000 to August 2020. A total of 19 586 highly myopic eyes from 28 studies were included. Modern cataract surgery turns out efficacious in highly myopic eyes with significant improvement of visual acuity. However, phacoemulsification-related complications such as posterior capsular rupture (3.91%, 95% CI, 1.98%-6.37%), retinal detachment (1.74%, 95% CI, 1.36%-2.15%), progressed myopic traction maculopathy (5.07%, 95% CI, 1.80%-9.37%), capsular contraction syndrome (2.1%), intraocular lens dislocation (0.58%), and transient intraocular pressure elevation (28.15%, 95% CI, 20.29%-36.70%) occurred more frequently in the highly myopic population. Separate analyses were also conducted based on follow-up period. In conclusion, modern cataract surgery was effective for highly myopic cataract patients, whereas careful precautions and sufficient follow-ups were of great value because of higher incidences of intraoperative and postoperative complications.

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.

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery.

Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.

Оценка динамических показателей УБМ при контракционном капсулярном синдроме до и после лазерного лечения

Оценка динамических показателей УБМ при контракционном капсулярном синдроме до и после лазерного лечения

Методика хирургической профилактики капсулярного контракционного синдрома в ходе факоэмульсификации

Методика хирургической профилактики капсулярного контракционного синдрома в ходе факоэмульсификации

Сравнительное ОКТ-исследование различных способов профилактики контрактуры капсульного мешка хрусталика у пациентов с псевдоэксфолиативным синдромом

Сравнительное ОКТ-исследование различных способов профилактики контрактуры капсульного мешка хрусталика у пациентов с псевдоэксфолиативным синдромом

Intraoperative wavefront aberrometry to determine planar endpoint for the repositioning of vaulted accommodative IOLs.

Accommodative intraocular lenses (IOLs) are suitable options for patients desiring less dependence on spectacles after cataract surgery. Accommodative IOLs do not require diffractive optics and, therefore, might be used in a wider range of patients who have mild comorbidities or wish to avoid photopsia associated with diffractive IOLs. However, a small percentage of patients have experienced vault, or capsular contraction syndrome (CCS), due to fibroblastic metaplasia of lens epithelial cells. Early detection of CCS might be managed with Nd:YAG capsulotomy; however, accommodative IOLs with significant CCS have required viscodissection of the fibrosis and placement of a capsular tension ring. A challenge with this maneuver is using the operating microscope to determine whether the accommodative IOL has returned to planar position. This article describes a new technique using serial intraoperative wavefront aberrometry measurements of lenticular astigmatism during accommodative IOL repositioning to determine a planar endpoint in the reduction of vault.

Application of capsular bag relaxation for capsular contraction syndrome.

The present study analyzed the surgical method and clinical effects of capsular bag relaxation surgery (CBRS) for the treatment of capsular contraction syndrome (CCS), which usually occurs post-phacoemulsification. The retrospective case study comprised of a total of 25 patients (25 eyes) who developed CCS after phacoemulsification and subsequently underwent CBRS. Among these patients, 15 patients (15 eyes) received actinoid relaxing incisions and 10 patients (10 eyes) underwent a second continuous curvilinear capsulorhexis. Postoperative naked-eye visual acuity was determined and compared with preoperative naked-eye visual acuity. Size changes of the transparent zone of the anterior capsule opening were observed under a slit lamp, as well as the anterior and posterior capsular membrane conditions and position of the intraocular lens (IOL). In addition, the presence of any subjective symptom, including glare or monocular diplopia, was investigated. A final 6-month postoperative follow-up was conducted for each patient. Visual acuity of all operated eyes improved to various extents. Notably, glare and monocular diplopia were no longer evident and patients could observe things clearly. Visual differences pre- and post-surgery were statistically significant (u=5.143, P<0.01). In addition, capsular bag shrinkage and relaxation were revealed under a slit lamp, the area of the transparent zone of the anterior capsule opening was expanded and the IOL remained centered. To conclude, CBRS is an effective treatment method for patients with CCS who are not suitable to receive laser treatment.

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.