Capsulorhexis Phimosis With Anterior Flexing of Accommodating IOL: Case Report and Laboratory Analyses

Epstein, Rachel

Capsulorhexis Phimosis With Anterior Flexing of Accommodating IOL: Case Report and Laboratory Analyses

Sunday, April 27, 2014: 4:01 PM

Room 151A (Boston Convention and Exhibition Center)

Rachel Epstein, MD, University of Chicago, Chicago, IL, USA

Erica T. Liu, MD, University of Utah Moran Eye Center, Salt Lake City, UT, USA

Liliana Werner, MD, PhD, John A. Moran Eye Center, Salt Lake City, UT, USA

Thomas Kohnen, MD, PhD, Goethe-University, Frankfurt, Germany

Nick Mamalis, MD, Moran Eye Ctr/Univ of Utah, Salt Lake City, Utah, USA

Oliver K. Klaproth, Goethe-University, Frankfurt am Main, Germany

Narrative Responses:

Purpose
We describe the case of a patient who underwent cataract surgery with implantation of an accommodating hydrophilic acrylic intraocular lens (IOL), exhibiting capsulorhexis phimosis and in-the-bag IOL luxation leading to explantation of the IOL-capsular bag complex 10 years after implantation.

Methods
Retrospective chart review, laboratorial analyses, and literature search.

Results
Constriction of the capsular bag secondary to fibrosis caused significant anterior flexing of the haptic elements of the lens. Histopathological analysis revealed dense anterior subcapsular fibrosis and fibrous metaplasia of the anterior lens epithelial cells. No signs suggestive of pseudoexfoliation were found.

Conclusion
This case raises concerns related to the continuously evolving indications for implantation of accommodating and other highly flexible IOLs (e.g., microincision lenses), particularly in patients with no clear predisposition to zonular weakness and accordingly, excessive capsular bag contraction.