Capsule contraction syndrome with haptic deformation and flexion

Abstract

We report a case series of capsule contraction syndrome in 5 eyes of 4 patients and describe a previously unreported complication: full flexion of the haptics onto the anterior surface of the optic. Haptics have been reported to slide anterior to the optic while remaining in their original coronal plane. As surgeons move to the use of preloaded injectable IOLs, it is important to scrutinize haptic-optic junction design and IOL material in the light of this complication.

Anterior capsule phimosis in presence of capsular tension ring

“…Many of the reported cases of anterior flexing of haptics have been in eyes in which a 4-looped single-piece hydrophilic acrylic intraocular lens (IOL) had been implanted. [1][2][3] This phenomenon has also been reported with single-piece hydrophobic IOLs. 4,5 The common factor in these cases is pliable IOL material, although IOL design could also play a part in certain cases.…”

Capsule Contraction Syndrome with a Microincision Foldable Hydrophilic Acrylic Intraocular Lens: Two Case Reports and Review of the Literature

“…We believe that the first treatment should always be performed with Nd:YAG laser anterior capsulotomy, unless an evident luxation of the complex IOL capsular bag is present. In fact, as reported by Ozturk et al [16] and by Michael et al [22], surgical treatment may lead to severe complications, notwithstanding a well-conducted original phacoemulsification, which is mainly the result of the capsular bag removal. In these cases, the authors [16, 22] did not report any previous attempts of treatment with Nd:YAG laser anterior capsulotomy (table 1).…”

“…The literature data shows that CCS has occurred in eyes with and without risk factors after the implantation of every IOL type (PMMA, silicone and acrylic); however, looking at the most recent reports, CCS has mainly developed after hydrophilic acrylic IOL implantation (in 1 case after implanting Akreos MI60 [18], in 1 case after Raysoft 574 R, Rayner Intraocular lenses, Ltd. [23], in 1 case after Bioacryl, Biotech [23], in 5 cases after Quatrix IOL, Croma Pharma GmbH [22], and in 6 cases after implanting an Akreos IOL lens [19, 20, 21]) (table 1). …”

“…The material and design of intraocular lenses (IOLs) have been hypothesized to play a role in anterior capsule opacification, the milder form of the disease [2]. However, CCS has been reported to occur with different types of IOLs, including polymethylmethacrylate, silicone and acrylic [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24]. Herein, we illustrate 2 cases of CCS following microincision cataract surgery without any associated ocular or systemic disease and we also review the literature on the subject (table 1).…”

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

“…In advanced cases, intraocular lens decentration and flexion of the haptics onto the anterior surface of the optic can occur. 3 Once formed, removal of fibrosis often needs surgical removal. 4 Nd:YAG opening frequently requires excessive laser energy with complications such as IOL pitting, cystoid macular oedema, or residual fibrotic material in the anterior chamber that may lead to inflammation and secondary glaucoma.…”