Rapidly progressive bilateral lens abnormalities following cataract surgery in a highly myopic patient

Axial high myopia (AHM) combined with complicated cataract elevates cataract surgery risks, and capsular contraction syndrome (CCS) is a rare postoperative complication with high myopia as a high-risk factor. Nevertheless, the simultaneous occurrence of postoperative CCS in one eye and spontaneous complete crystalline lens dislocation in the contralateral unoperated eye has not previously been reported in the AHM population.

A 60-year-old woman with long-standing high myopia and bilateral nuclear cataract underwent right eye cataract surgery. The right eye developed rapidly progressive CCS with anterior capsular shrinkage and intraocular lens (IOL) decentration at 4 and 5 weeks postoperatively, requiring multiple surgical interventions including anterior vitrectomy and IOL replacement. During the same period, the untreated left eye developed spontaneous complete posterior dislocation of the crystalline lens into the vitreous cavity and was managed with pars plana vitrectomy (PPV), lensectomy, and secondary suture-suspended IOL implantation.

This case underscores two core clinical recommendations for cataract surgery in patients with AHM. Rigorous preoperative counselling is essential to inform patients comprehensively about the risks of CCS, which may necessitate successive secondary surgical procedures ranging from neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy, IOL repositioning or exchange and scleral-fixated IOL implantation to anterior vitrectomy and PPV, and these interventions may result in permanent visual loss. Additionally, rigorous surveillance of zonular integrity and native lens stability in the contralateral eye is mandatory for high myopia patients diagnosed with postoperative CCS.