Capsulorhexis phimosis with anterior flexing of an accommodating IOL: case report and histopathological analyses

We describe the case of a patient who had cataract surgery with implantation of an accommodating hydrophilic acrylic intraocular lens (IOL) that exhibited capsulorhexis phimosis and in-the-bag IOL luxation leading to explantation of the IOL-capsular bag complex 10 years after implantation. Constriction of the capsular bag secondary to fibrosis caused significant anterior flexing of the haptic elements of the IOL. Histopathological analysis revealed dense anterior subcapsular fibrosis and fibrous metaplasia of the anterior lens epithelial cells. No signs suggestive of pseudoexfoliation were found. This case raises concerns related to the continuously evolving indications for implantation of accommodating and other highly flexible IOLs (eg, microincision IOLs), particularly in patients with no clear predisposition to zonular weakness and, accordingly, excessive capsular bag contraction.