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Can capsular phimosis be prevented?
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A patient comes to see you 1 year after cataract surgery in his left eye. He is 68 years old with a history of pseudoexfoliation. The eye is shown in the photo here, and the current vision is 20/200 with a mild improvement with pinhole testing. The right eye has a 3+ nuclear cataract, giving 20/100 vision.
 Severe capsular phimosis . |
It appears that the surgery of the left eye was performed well, but the eye suffered from severe capsular phimosis during the postoperative period. There is a single-piece acrylic IOL in the capsular bag, with the optic reasonably centered but with one of the haptics folded over due to the extreme capsular contraction.
Are there ways that we can prevent capsular phimosis? Alan Crandall, MD, has taught me that a larger capsulorrhexis (5.5 mm or even larger) is better than a small capsulorrhexis in these pseudoexfoliation eyes. Others have recommended a capsular tension ring to help resist the forces of phimosis. A thorough cleanup of the lens epithelial cells from the anterior lens capsule helps. And perhaps even performing prophylactic radial incisions to the capsulorrhexis after IOL implantation may help.
What would you do to help prevent this complication from happening to the patient's other eye?
Get more expert perspective from Dr. Devgan live at Hawaiian Eye 2010, to be held January 17-22, 2010 at the Grand Hyatt Kauai. Learn more at OSNHawaiianEye.com.