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
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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.
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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)