Capsule Contraction Syndrome Research Articles

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.

Current possibilities of laser surgery on anterior eye segment

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 μm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

Коррекция дислокации гаптического элемента торической ИОЛ у пациента после факоэмульсификации и склеральной фиксации модифицированного капсульного кольца при синдроме Марфана

Purpose. To propose a surgical technic for correcting the dislocation of the haptic element of the toric intraocular lens (IOL) in a patient after phacoemulsification and scleral fixation of the modified capsular ring in Marfan syndrome (MS). Material and methods. To report a case about dislocation one of the haptic elements of a toric IOL out of the capsular bag as a result of contraction of the capsular bag in a patient with MS in the presence of sutured modified capsular tension ring. The patient underwent a comprehensive ophthalmological examination, including refractometry, eye biometry, ophthalmoscopy, fundus examination for medical mydriasis, keratotopography, computed tomography of the cornea, and surgical treatment. Results. Removal and peeling of fibrous tissue, located under the anterior capsule with a reposition of the haptic of toric IOL resulted in significant astigmatism reduction and visual functions improvement. Conclusion. The proposed surgical technic for dissection of the anterior capsule fibrosis and reposition of the IOL haptics is effective for restoring the anatomically correct position of the IOL, and also allows to obtain a good functional result. To the best of our knowledge, successful treatment of late postoperative residual astigmatism with IOL tilt under conditions of transscleral fixed modified capsular tension ring (M-CTR) with haptic dislocation from the capsular bag and the presence of contraction capsular syndrome in SM has not been previously described in the literature. Key words: Marfan syndrome, capsule contraction syndrome, modified capsular tension ring, phacoemulsification, toric IOL result. To the best of our knowledge, successful treatment of late postoperative residual astigmatism with IOL tilt under conditions of transscleral fixed modified capsular tension ring (M-CTR) with haptic dislocation from the capsular bag and the presence of contraction capsular syndrome in SM has not been previously described in the literature.

Surgical Treatment of Patients with Dislocation of IOL — Fibrosed Capsule Bag Complexes

Violation of the correct location of the complex IOL capsule bag (CICB) in the delayed postoperative period occurs with a frequency of 0.2 to 2.8 %. The basis of the pathogenesis of this complication is the destruction of the zonal ligament due to progressive pseudoexfoliative syndrome, as well as the process of fibrosing the capsule bag. The stage of the flow and the different degree of severity of each mechanisms determines the variety of clinical manifestations. CICB dislocation in combination of these two mechanisms requires a special approach to treatment.Objective: to develop a system of surgical treatment of IOL dislocations in contract capsule syndrome, with varying degrees of severity, combined with the weakness of the ligament apparatus of the lens, and to present the results of its use.Patients and methods. Retrospective analysis of 55 cases of CICB dislocations with the observation period of more than 4 years operated in 2014-2016. Number of dislocations with certain IOL type: Hydrophilic monolithic — 27, Hydrophilic monolithic — 11, Hydrophilic three-part — 10, Hard — 7. The selection criterion was the presence of CICB dislocation in the combination of weakness of the ligament apparatus (II–III st. of severity) and contraction capsule syndrome, with varying degrees of severity. A system is proposed to allow a low-invasive repositioning of intraocular lenses dislocated with a fibrous capsule bag with subsequent suture fixation to the iris. Signs used for choice of surgical technique: localization of capsule bag fibrosis, contract effect of capsule bag fibrosis on IOL position and correct location of haptic elements, size, and severity of equatorial lens masses (Semmering ring). In cases when insufficiency of the ligament apparatus prevails, with insignificant fibrosis of the capsule bag, without contractional influence, fixation of KIKM to iris is carried out without cutting of the capsule bag (method 1). As the fibrous changes of the front or back leaf of the capsule progress without changing the position of IOL inside the capsule bag due to contraction, along with fixation of KIKM, the fibrous front/back capsule is excised (method 2). The variant of complete removal of the fibrous capsule bag is used in faraway stages of CCS with further fixation of IOL to the iris (method 3).Results. The data of BCVA and IOP of patients treated by a certain method (before the operation, early postoperative period (2–5 days), delayed period (more than 4 years)) are presented.Conclusion. Surgical treatment of patients with CICB dislocation combining manifestations of Capsule contraction syndrome and weakness of the lens ligament apparatus can now be standardized using a proper approach and certain methods of treatment, but requires a comprehensive assessment of such parameters as the safety of the ligament apparatus, the localization and degree of fibrous changes of the anterior / posterior capsule, the contractional effect of the capsule bag fibrosis on the front position of the IOL optics and the correct location of the haptic elements, the severity of the ring.

Comparison Study of Anterior Capsule Contraction of Hydrophilic and Hydrophobic Intraocular Lenses Under the Same Size Capsulotomy.

PurposeTo compare anterior capsule contraction of two kinds of hydrophilic and hydrophobic acrylic intraocular lenses (IOLs) under the same size capsulotomy with femtosecond laser-assisted cataract surgery (FLACS).MethodsA total of 320 eyes in 320 patients who underwent FLACS were included. The patients were scheduled to have hydrophilic acrylic IOLs (MI60, 509M) and hydrophobic acrylic IOLs (iSert250, ZCB00) implanted. Visual acuity and anterior segment photography using a slit lamp microscope were performed at postoperative one week, one month, three months, and one year.ResultsThe contraction of the anterior capsule opening area (mm2) and circumference (mm) in the hydrophilic group were larger than that of the hydrophobic group from postoperative one week to one year (P < 0.001, P < 0.001, respectively). The postoperative contraction of the capsule opening area in MI60 was larger than in 509M (P < 0.001) and larger in 509M than in iSert250 and ZCB00 (P = 0.008, P = 0.019, respectively), but no difference was observed between iSert250 and ZCB00 (P = 0.867). During postoperative one to three months, all groups had the maximum capsule contraction (P < 0.001).ConclusionsUnder the same size capsulotomy with FLACS, the postoperative anterior capsule contraction induced by hydrophobic IOLs was less than that induced by hydrophilic IOLs. Among the four IOLs, the capsule contraction was largest in MI60, followed by 509M, and least in iSert250 and ZCB00, which was time-dependent.Translational RelevanceOur findings implied that patients with a high risk of ACC should choose hydrophobic IOLs, as well as nonsteroidal anti-inflammatory drugs may be used for a longer period in patients with high risk of capsule contraction syndrome.

Enlargement of Phimotic Capsulorhexis Using Plasma Energy: A Case Series

Purpose: to evaluate the effectiveness and safety of the plasma ablation technique of Fugo blade system to enlarge phimotic capsulotomies in the management of anterior capsule contraction syndrome.Patients and methods. Results of the enlargement of phimotic capsulotomies using the plasma ablation technique in 17 patients with anterior capsule contraction syndrome (10 men and 7 women, 18 eyes; average age — 73.8 ± 9.6 years) were retrospectively analyzed. Surgically, after pupil dilation, the anterior chamber was irrigated with a viscoelastic device (1.4 % solution of hyaluronic acid), and the tip of the Fugo blade was inserted through a 2.0–2.2 mm wide corneal incision. After slightly touching the anterior capsule, the apparatus was activated, and its tip was moved in a concentric manner, excising the required size of the fibrosed anterior capsule in a resistance-free fashion. Finally, the viscoelastic material was aspirated, and the incisions were hydrated.Results. Phimotic capsulotomies were enlarged in all cases. Except for three cases where the bimanual technique was required to ablate the anterior capsule, all other cases were managed single-handedly. The use of cohesive viscoelastic device (1.4 % solution of hyaluronic acid) made it possible to perform this procedure with minimum trauma and under visual control. No serious complications were encountered during surgery or in the early postoperative period. Patients were discharged 1–2 days after surgery. Corneal edema, which was observed in six eyes, resolved within 3–4 days. Visual acuity improved in all cases, except for 2 patients with complete glaucomatous optic atrophy. IOP remained under control in all cases. No negative effect on the hypotensive results of previous glaucoma surgeries was observed.Conclusion. The plasma-generating Fugo blade system is an effective and safe tool to enlarge phimotic capsulorhexis in a resistance-free fashion. It is easy to use, mastering of new surgical skills is not required, surgical trauma is minimal, the surgical time is reduced, and the patient’s rehabilitation period is significantly shortened.

Case series: \u201cDouble arch\u201d changes caused by capsule contraction syndrome after cataract surgery in highly myopic eyes

BackgroundCapsule contraction syndrome (CCS) after cataract surgery causes intraocular lens (IOL) haptic flexion and IOL optic displacement in most former reports. However, there are few reports on CCS-induced deformation of the IOL optic. We report two cases of CCS after cataract surgery in highly myopic eyes and describe a previously unreported “double arch” complication.Case presentationTwo patients with history of high myopia had cataract surgery with hydrophilic acrylic plate haptic IOLs implanted in their eyes. CCS with arch shape deformation of the pupil as well as the optic of the IOL were noticed in both cases after three months, which induced refractive changes and corrected distance visual acuity (CDVA) deterioration. Visual acuity of the patients was restored by replacing the IOL from the capsular bag to the ciliary sulcus and the following neodymium: YAG (Nd:YAG) laser capsulotomy. We propose that such “double arch” change brought by CCS is related to the plate-haptic design of the IOL and the incomplete overlap between the capsular opening and the IOL optic.ConclusionsWe recommend careful IOL selection and proper capsulorhexis in patients with high myopia or with other risk factors of CCS. Early diagnosis and timely treatment of CCS are critical to prevent visual symptoms and further ocular complications.

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.

A Modified Femtosecond Laser Technique for Anterior Capsule Contraction Syndrome.

Anterior capsule contraction syndrome (ACCS) is a rare, late complication of cataract surgery, associated with impairment of visual function. In this paper, we describe a new surgical technique to treat ACCS by femtosecond laser procedure. The femtosecond laser was used to perform an anterior capsulotomy with a customized size, in order to avoid IOL damage. After ophthalmic viscosurgical device injection in the anterior chamber, the anterior capsule flap was separated from the IOL surface by gentle hydrodissection. This manoeuvre enabled an easy and safe removal of the fibrotic material by vitreal microscissors. Our technique allowed a complete removal of the fibrotic material and opening of the capsule, with immediate complete visual acuity recovery without IOL damage. In conclusion, femtosecond laser appears to be safe and effective for treatment of ACCS with long-lasting efficacy.

Anterior capsule contraction syndrome: a successful multimodal therapeutic approach

Anterior capsule contraction syndrome: a successful multimodal therapeutic approach

Hyperopic shift caused by capsule contraction syndrome after microincision foldable intraocular Lens implantation: case series

BackgroundIncreasing interest in microincision cataract surgery has led to the use of more flexible intraocular lens (IOL). Flexible IOL may cause more IOL deformation and refractive error when capsule contraction syndrome (CCS) occurred. In this retrospective observational case series study, the aim was to report four cases of hyperopic shift caused by CCS after phacoemulsification with microincision foldable intraocular lens implantation.Case presentationAll of four patients underwent phacoemulsification and in-the-bag implantation of an Akreos MI60 (Bausch and Lomb) IOL from 2010 to 2016 in our clinic. These patients had been diagnosed with CCS and had undergone Nd:YAG laser anterior capsulotomy. The mean age of the patients with CCS was 66.8 ± 6.7 years and the mean time for development of CCS after the cataract surgery was 9.3 ± 6.9 months. The mean spherical equivalent (SE) value at the time of the CCS diagnosis was 0.88 ± 0.91 D, which had shown a hyperopic shift compared to the SE value of − 0.91 ± 1.29 D after cataract surgery. The mean SE decreased by − 0.47 ± 1.14 D after Nd:YAG laser anterior capsulotomy. The mean age, axial length, anterior chamber depth, and preoperative SE were not significantly different between the patient with CCS and the patients without CCS.ConclusionsIn the case of IOL implantation with flexible materials in microincision cataract surgery, CCS can cause a hyperopic shift. Refractive error caused by CCS can be effectively corrected by Nd:YAG laser anterior capsulotomy.

Capsule Contraction Syndrome: Incidence, Pathogenesis, Prevention and Treatment Alternatives

Capsule Contraction Syndrome: Incidence, Pathogenesis, Prevention and Treatment Alternatives

Capsule contraction syndrome in pseudophakia

This is a review of the literature on capsule contraction syndrome (CCS) in pseudophakic patients that involves severe fibrosis along the margin of the anterior capsule's opening and progressive contraction of the capsular bag. Possible causes of CCS and principles of its prevention and treatment have been analyzed.

Treating capsule contraction syndrome with a femtosecond laser

None of the authors has a financial or proprietary interest in any material ormethod mentioned.

Postoperative membranous proliferation outgrowth onto the anterior surface of hydrophobic acrylic intraocular lenses

Purpose: The aim of this study was to determine the correlation factors and features of membranous outgrowth onto the anterior surface of hydrophobic acrylic intraocular lenses. Methods: This study included 145 eyes from 135 consecutive patients who had cataract surgery with implantation of a single-piece, foldable, hydrophobic acrylic intraocular lens. Postoperatively, the IOL optic was examined by slit-lamp microscopy at 1 week and1 month to determine the incidence, extent, and correlation factors of membranous proliferation. If MP was present, we re-examined the patient monthly to monitor the condition. The extent of this proliferation was assessed using a clock-face representation of the IOL optic as the number of hours in which membranous proliferation could be identified. Results: Twenty-four eyes were excluded from analysis and 121 remaining eyes were studied. Membranous proliferation was documented in 46 (38.02%) of the pseudophakic eyes. Furthermore, the incidence of membranous outgrowth was greater in pseudophakic eyes characterized by older age, shorter axial length and more serious anterior segment vitreous opacity. Membranous proliferation was greater in the inferior (35.11%) and nasal quadrants (33.51%) than in the superior and temporal quadrants (where the incisions were made). The total area of membranous proliferation was slightly less than one quadrant (56.52%). Conclusions: Shorter axial length, older age, serious anterior segment vitreous opacity, and the inferior and nasal quadrants are risk factors for membranous proliferation on the IOL surface. Appreciation of these risk factors may lead to establishing procedures that will lessen anterior capsule opacification and capsule contraction syndrome simultaneously.

Elevated TGF-β2 level in aqueous humor of cataract patients with high myopia: Potential risk factor for capsule contraction syndrome

To evaluate the level of transforming growth factor-β2 (TGF-β2) in the aqueous humor of highly myopic cataract patients and its correlation with capsule contraction syndrome. Eye and ENT Hospital of Fudan University, Shanghai, China. Prospective comparative case series. The highly myopic cataract patients were divided into the following 2 groups according to the Lens Opacity Classification System III: nuclear color (NC) 2 to 3 and NC 5 to 6. Aqueous humor TGF-β2 concentrations were assayed in the highly myopic cataract and age-related cataract groups. The TGF-β2, TGF-βRII (the type II receptor for TGF-β2), and α-smooth muscle actin (α-SMA) expressions in lens epithelial cells (LECs) were detected by real-time polymerase chain reaction and immunofluorescent staining. The study comprised 40 highly myopic cataract patients (40 eyes) and 20 patients (20 eyes) with age-related cataract as the control group. Compared with the control group, the highly myopic cataract group had significantly higher TGF-β2 concentration in the aqueous humor and increased TGF-βRII expression in LECs, especially in NC 5 to 6 cases. Expression of α-SMA was barely detectable in both groups. In highly myopic cataract patients, especially those with dark nuclei, elevated aqueous humor TGF-β2 levels and the upregulated TGF-βRII expression in LECs might contribute to the pathogenesis of capsule contraction syndrome through transdifferentiation of LECs into myofibroblasts. None of the authors has a financial or proprietary interest in any material or method mentioned.

The clinical effect of Nd: YAG laser anterior capsulotomy for the treatment of capsular bag contraction syndrome

Objective To observe the clinical effect of Nd: YAG laser anterior capsulotomy for the treatment of capsular bag contraction syndrome(CCS) after intraocular lens implantation. Methods Eighty-five eyes of 85 cases of CCS were treated with Nd: YAG laser anterior capsulotomy. The minimum diameter of the anterior capsule opening, best corrected visual acuity(BCVA), corneal endothelial count and intraocular pressure (IOP) were observed 1 day preoperation and 1 week postoperation. The follow-up time was 6 months. Results The contractile ring of anterior capsule opening was opened and the contraction of capsule bag was released after Nd: YAG laser anterior capsulotomy. No serious complication was observed. The number of the eyes with BCVA≥0.3 was increased from preoperative 43 eyes to postoperative 52 eyes. The minimum diameter of the anterior capsule opening increased significantly, form (1.91±1.52)mm to (4.33±1.92)mm (t=7.45, P=0.00). No significant change in corneal endothelial cell counts after treatment was observed, (2304±202)/mm2vs (2281±234)/mm2 (t=1.03, P=0.15). IOP did not change significantly 1week postoperation compared to 1day preoperation, (15.53±4.34)mmHg vs (15.76±4.49) mmHg (t=0.62, P=0.27). No IOL shift was observed during 6 months follow-up. Conclusion Nd: YAG laser anterior capsulotomy is an effective treatment for CCS. No serious complication was observed after early surgical treatment. Key words: Cataract; Capsule contraction syndrome; Laser anterior capsulotomy; Intraocular pressure

Clinical research of different surgical modes for the treatment of severe capsule contraction syndrome

Objective To observe the clinical effect of different surgical methods for the treatment of severe capsule contraction syndrome. Methods Twenty-three eyes of 23 cases of severe capsule contraction syndrome were treated with operation. According to the condition of patients, 12 eyes underwent anterior capsulotomy with intraocular lens(IOL) adjustion in the capsule, 6 eyes underwent anterior capsulotomy with IOL ciliary sulcus fixation, and 5 eyes underwent IOL removal with vitrectomy and IOL ciliary sulcus suture fixation. The follow-up time was 3 months, and the visual acuity, anterior chamber reaction, position of intraocular lens, condition of the anterior and posterior capsule were measured respectively. Results The visual acuity improved postoperatively in all eyes. The size of the transparent area of the capsularhexis holes which underwent anterior capsulotomy significantly increased comparing with that before surgery. The complications such as glare and monocular diplopia in 6 cases disappeared after Nd: YAG laser posterior capsulotomy 1 month after the operation. Among the three different kinds of surgery procedures, postoperative best corrected visual acuity were all improved evidently one month after the surgery. The differences were statistically significant when compared with that of preoperation (P 0.05). Anterior chamber reaction of IOL ciliary sulcus suture fixation cases was the most obvious one, and it returned to normal within a week after appropriate treatment. The IOL were all centered in the capsule, and no other complication was observed during the follow-up of 3 months after operation. Conclusion Various surgical methods for severe capsular contraction syndrome are effective, satisfactory and safe.The right operation methods should be chosen according to the patients' condition. Key words: Cataract; Capsule contraction syndrome; Treatment, surgical

The treatment for capsular contraction syndrome

Objective To investigate the treatment method for capsule contraction syndrome after cataract phacoemulsification. Methods A series of 19 eyes of 19 cases with capsule contraction syndrome after cataract phacoemulsification were investigated. Patients in incipient and progressive stage of capsule contraction syndrome were treated by Nd: YAG laser anterior capsulotomy, and severe ones were treated by capsulolysis. The postoperative best corrected visual acuity, anterior chamber reaction, anterior capsule status, location of IOL and intraocular pressure(IOP) were observed during following up period of 1 to 6 months. Results The best corrected visual acuity after operation were significantly improved in all cases comparing with that before the operation, and the difference was statistically significant(P 0.05). The difference of IOP between postoperative 1 month and 6 month was not statistically significant either(P>0.05); The difference of postoperative IOP between Nd: YAG laser anterior capsulotomy and anterior capsulolysis was not statistically significant (P>0.05). The diameter of anterior capsular optical zone ranged from 5.5 to 6 mm. All intraocular lens situated within the capsular bag without decentration or tilt. Anterior chamber reaction was mild. No capsular rupture, zonule tears or other severe complication were observed. Conclusion Nd: YAG laser anterior capsulotomy and capsulolysis are safe and effective for the treatment of capsule contraction syndrome. Nd: YAG laser anterior capsulotomy is suitable for the treatment of incipient and progressive stage of capsule contraction syndrome. The capsulolysis is suitable for the treatment of severe capsule contraction syndrome. Key words: Syndrome, contraction, capsule; Capsulotomy, anterior, Nd: YAG laser; Capsulolysis

Surgery for capsule contraction syndrome

Objective To evaluate the efficacy of surgical treatment for capsule contraction syndrome after phacoemulsification.Methods The sac-relaxing surgery was performed on 12 eyes of 12 cases with capsule contraction syndrome after phacoemulsification.The visual acuity and complication were observed.Results The visual acuities were improved in all the 12 eyes after surgery.The visual acuities of 10 eyes were better than 0.4,and those of 2 eyes were 0.1-0.3.No complication was found in all cases.Conclusion Surgery for capsule contraction syndrome is a safe and effective way. Key words: Cataract ; Phacoemulsification; Capsule contraction syndrome ; Surgery, sac-relaxing