Risk factors for capsular phimosis following congenital cataract extraction

Visual axis opacities are one of the most common complications following infantile cataract surgery. To date, most studies have focused on lens reproliferation and pupillary membranes rather than capsular phimosis. We evaluated risk factors for capsular phimosis after lensectomies in infants.

A retrospective chart and video review of patients seen at a single institution over a period of 4 years was performed. Exclusion criteria were follow-up of <7 months and poor video quality. Two independent examiners, masked to patient outcomes, calculated capsulotomy diameters from video stills. To analyze risk factors for capsular phimosis, the χ² test was used for categorical variables; the independent t test for continuous variables. For bilateral cases, one eye was randomly included in capsulotomy analysis.

A total of 20 eyes of 12 patients, aged 1.7 months (IQR, 1.25; range, 0.6-3.2) at time of surgery, were reviewed. Median follow-up was 1.7 years (IQR, 2.39; range, 0.5-3.9). Capsular phimosis developed in 7 eyes (35%) and required surgical intervention in 5 eyes (25%) a median of 2.3 months (IQR 1.49; range, 1.2-5.1) after primary surgery. Male sex (P = 0.03) and smaller anterior horizontal (4.31 vs 5.78 mm [P = 0.0039]), anterior vertical (4.67 vs 5.59 [P = 0.0131]), and posterior vertical (4.10 vs 5.08 mm [P = 0.00074]) capsulotomy diameters increased risk of phimosis.

In our study cohort, capsular phimosis was a common complication following a lensectomy in infants. Smaller anterior and posterior capsulotomy diameters increase risk of capsular phimosis.