Anterior capsulectomy for anterior capsule phimosis: surgical technique and outcome

Session Details

Session Title: IOL Dislocation & Opacification

Session Date/Time: Tuesday 25/09/2018 | 14:00-16:00

Paper Time: 14:42

Venue: Room A3, Podium 1

First Author: : D.S Patel UK

Co Author(s): :    L. Goh   S. Isherwood   M. A Elgohary              

Abstract Details

Purpose:

To present the surgical technique and visual outcomes of anterior capsulectomy in cases with severe anterior capsule phimosis following cataract surgery with single piece hydrophilic acrylic intraocular lens (IOL) implants.

Setting:

Royal Eye Unit, Kingston Hospital, Kingston Upon Thames, England, UK

Methods:

Five patients with visually disabling anterior capsule phimosis (capsular aperture ≤ 4mm) underwent surgical capsulectomy. Co-morbidities included two cases with persistent cystoid macular oedema, one with geographic atrophy, one with previous uveitis and one with angle closure glaucoma. One case had undergone unsuccessful YAG laser anterior capsulotomy. Four clear corneal 1.7mm stab incisions were made, separated by 90 degrees. The fibrotic anterior capsule and IOL were separated with viscodissection. Coaxial 23-guage micro-grasping forceps were used to stabilise the anterior capsule while micro-scissors were used to segmentally enlarge the anterior capsule opening. Intracameral viscoelastic was removed with bimanual irrigation and aspiration.

Results:

In all five cases, anterior capsulectomy resulted in a larger anterior capsule opening post-operatively. All patients reported improvement in vision. In all cases, best recorded Snellen visual acuity was either equal to or better than that recorded pre-operatively (range 0 to +3 lines). A lack of acuity gain was associated with pre-existing macular or optic nerve pathology. In one patient, generalised improvement in global indices was demonstrated on Humphrey’s visual field test. Both cases with persistent cystoid macular oedema resolved with no recurrence. There were no intraoperative or postoperative complications over a mean follow-up of 121 days.

Conclusions:

Anterior capsulectomy with 23G vitrectomy instrumentation is a safe and effective method of increasing the anterior capsule opening diameter and results in improved vision even in the presence of co-morbidities which may limit visual potential. It should be considered as a primary procedure in cases of severe phimosis and when YAG laser risks intraocular pressure spikes, inflammation or lens dislocation.

Financial Disclosure:

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