Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

Abstract

Purpose To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics. Methods A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described. Results We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases. Conclusion This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation.

A Modified Femtosecond Laser Technique for Anterior Capsule Contraction Syndrome

“…Despite the high success rate, this technique has unpredictable efficacy in restoring visual acuity in patients with thick fibrosis. Moreover, several complications have been described such as IOL pitting, cystoid macular edema, or residual fibrotic material in the anterior chamber that may cause inflammation and secondary glaucoma [1,11,[16][17][18][19].…”

“…Alternatively, surgical removal of the fibrous membrane may be performed by capsulorhexis to peel the fibrotic capsule, using microincisional scissors or vitrector-cut capsulotomy [16,20,21].…”

“…is procedure allows a better centration of the IOL, but may be complicated by lens dislocation in case of zonular weakness. Zinkernagel et al described a minimally invasive surgical technique using standard 23-gauge vitreoretinal forceps and horizontal scissors to bimanually remove the fibrotic anterior capsule and to perform haptic amputation [16]. However, a potential risk of IOL or iris damage may be associated with the use of vitrector scissors.…”

Airways Surface Liquid and Ion Transport - The Mechanism Maintained Patency

“…The airway epithelium is covered with a thin, liquid protective layer -Airways Surface Liquid (ASL) [1]. ASL is created and maintained by water and ion transport, especially sodium and chloride [2][3][4][5][6][7][8]. Its task is to create an ideal environment that allows proper gas exchange through the respiratory epithelium [9][10][11][12][13].…”

Anterior capsular phimosis

“…Anterior capsule phimosis is the centripetal constriction and fibrosis of the anterior lens capsule, and has been reported to occur after cataract removal in 1.4% to 5% cases 12. Delayed diagnosis can cause permanent vision loss.…”