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

Abstract

Background: Increasing 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 presentation: All 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.

Conclusions: In 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.

Keywords: Capsule contraction syndrome; Intraocular lens; Microincision cataract surgery; Nd:YAG laser anterior capsulotomy; Refractive change.

Fig. 1

Anterior photographs of case 1 before (a, b) and after (c, d) Nd:YAG laser treatment. a Slit lamp examination shows contraction of the capsulorhexis opening and a thick anterior lens capsule margin (yellow arrow). b The intraocular lens (yellow line) reveals posterior bowing and an unusual deepening of the anterior chamber is observed (red arrow). c After relaxing the phimosis via the Nd:YAG laser anterior capsulotomy (yellow arrowhead), contraction of the capsulorhexis opening was released. d) The intraocular lens (yellow line) is flat and the anterior chamber depth (red arrow) is decreased compared to before the Nd:YAG laser treatment

Fig. 2

Illustration of posterior bowing of intraocular lens after capsule contraction syndrome. a Before capsule contraction syndrome occurs, parallel light is focused on the fovea. b After capsule contraction syndrome, hyperopic shift occurs due to posterior bowing of the intraocular lens. The diagram was illustrated by Dr. Tae Gi Kim using Paint.NET software (Version 4.1)