Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report

BMC Ophthalmology, Dec 2016

Background To report a case of postoperative fibrous membrane formation occluding the visual axis in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome. Case presentation A 79-year-old Asian woman with pseudoexfoliation syndrome underwent uneventful phacoemulsification and implantation of one-piece hydrophilic acrylic square-edged intraocular lens (Cristalens) in the right eye. Two months later, she had blurred vision in the right eye with the best-corrected visual acuity (BCVA) of 20/40. Formation of fibrous membrane occluding the capsulorhexis opening with contraction of anterior capsule was observed, which was confirmed by anterior segment optical coherence tomography. Clear visual axis was achieved by lysis of the membrane using Nd:YAG laser. The BCVA improved to 20/20. Conclusions Occlusion of the visual axis with fibrous membrane can develop in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.

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Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report

Kim et al. BMC Ophthalmology Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report Eung Suk Kim Moosang Kim 0 Seung-Jun Lee 0 Sang Beom Han 0 Hee Kyung Yang Joon Young Hyon 0 Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine , 156 Baengnyeong-ro, Chuncheon, Kangwon 200-722 , South Korea Background: To report a case of postoperative fibrous membrane formation occluding the visual axis in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome. Case presentation: A 79-year-old Asian woman with pseudoexfoliation syndrome underwent uneventful phacoemulsification and implantation of one-piece hydrophilic acrylic square-edged intraocular lens (Cristalens) in the right eye. Two months later, she had blurred vision in the right eye with the best-corrected visual acuity (BCVA) of 20/40. Formation of fibrous membrane occluding the capsulorhexis opening with contraction of anterior capsule was observed, which was confirmed by anterior segment optical coherence tomography. Clear visual axis was achieved by lysis of the membrane using Nd:YAG laser. The BCVA improved to 20/20. Conclusions: Occlusion of the visual axis with fibrous membrane can develop in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome. Anterior capsular phimosis; Anterior segment optical coherence tomography; Case report; Fibrous membrane; Nd; YAG Laser; Pseudoexfoliation syndrome - Background Anterior capsular phimosis (or anterior capsular contraction syndrome) is one of the complications of cataract surgery that occurs associated with continuous curvilinear capsulorhexis (CCC) [1]. It was described as an exaggerated fibrotic response reducing the size of the anterior capsulorhexis opening and equatorial capsular diameter [1]. It typically occurs in patients with conditions of zonular weakness and intraocular inflammation [1, 2], such as pseudoexfoliation [3–5], uveitis [1, 2], myotonic dystrophy [2], and retinitis pigmentosa [6]. Previous reports showed that severe anterior capsular phimosis can cause complete occlusion of the pupil [2, 3, 7, 8]. However, through a comprehensive search of the MEDLINE database, occlusion of visual axis with fibrous membrane in the presence of incomplete anterior capsular contraction with capsulorhexis opening of 3.0 mm has rarely been reported [2]. Although anterior segment imaging modalities including anterior segment optical coherence tomography (AS-OCT) is expected to visualize the occlusion of the capsular opening, there has been no report of application of the AS-OCT in the condition. We recently experienced a case of fibrous membrane formation occluding the visual axis accompanied with anterior capsular phimosis after an uneventful cataract surgery in a patient with pseudoexfoliation syndrome which was confirmed with AS-OCT, thus herein report the case. Case presentation A 79-year-old Asian woman with pseudoexfoliation syndrome was referred for cataract surgery in the right eye. Her past medical history was unremarkable. Her bestcorrected visual acuity (BCVA) was 20/50 in the right eye. © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. She underwent right phacoemulsification under topical anesthesia. As she had a small pupil of approximately 5.5 mm diameter, CCC with a diameter of 5.0 mm was performed without iris manipulation. Phacoemulsification was completed without any intraoperative complication, and a foldable one-piece hydrophilic acrylic square-edged intraocular lens (IOL) (22.0 diopters, 6.0mm optical diameter, 10.75mm overall diameter, model number: CLARE®; Cristalens, Paris, France) was implanted through a temporal corneal incision. Postoperatively, anti-inflammatory treatment with topical prednisolone acetate 1.0% 4 times daily was applied for 1 month. The BCVA was 20/40 at 1 week, which improved to 20/25 at 1 month. Two months after the surgery, she presented with blurred vision in the right eye. The BCVA was 20/40. Slit lamp examination after dilation revealed marked opacity and thickening of the anterior capsule. Anterior capsulorhexis opening reduced to a diameter of approximately 3.0 mm due to capsular contraction, and fibrous membrane occluding the capsulorhexis opening was observ (...truncated)


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Eung Kim, Moosang Kim, Seung-Jun Lee, Sang Han, Hee Yang, Joon Hyon. Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report, BMC Ophthalmology, 2016, pp. 213, 16, DOI: 10.1186/s12886-016-0394-y