Complete capsulorhexis opening occlusion despite capsular tension ring implantation

Area of Science:

• Ophthalmology
• Biomaterials Science

Background:

• Cataract surgery involves removing the clouded natural lens and replacing it with an artificial intraocular lens (IOL).
• Continuous curvilinear capsulorhexis (CCC) and phacoemulsification are standard techniques for lens removal.
• Silicone plate-haptic IOLs and capsular tension rings (CTRs) are used to manage specific surgical challenges, such as weak zonules.

Observation:

• Two elderly patients (89 and 86 years old) with presumed weak zonules underwent cataract surgery with CCC, phacoemulsification, and silicone plate-haptic IOL implantation.
• A poly(methyl methacrylate) CTR was implanted in both cases due to suspected zonular weakness (age, pseudoexfoliation).

Findings:

• Both patients experienced a decline in visual acuity approximately 3-4 months post-surgery.
• Postoperative examination revealed complete occlusion of the anterior capsular opening by fibrotic tissue in both eyes.

Implications:

• Fibrous tissue proliferation can compromise the anterior capsule opening, leading to visual impairment after cataract surgery.
• The effectiveness of CTRs in preventing anterior capsule fibrosis may be limited in certain patient populations.
• Further research is needed to understand and prevent this fibrotic complication to ensure long-term visual outcomes.