Anterior Capsular Phimosis Management

Pathophysiology and Risk Factors

Anterior capsular phimosis is caused by metaplastic lens epithelial cells leading to fibrosis and progressive shrinkage of the anterior capsular opening, with high-risk conditions including diabetes mellitus, uveitis, eyes with zonular pathology, and silicone IOL optic materials 1, 2, 3, 4
Retinitis pigmentosa is also a risk factor for anterior capsular phimosis 4

Visible shrinkage of the anterior capsular opening, IOL decentration or tilt are signs of anterior capsular phimosis 4

Assessment of IOL position and stability is crucial in the diagnostic approach of anterior capsular phimosis 5

Nd:YAG or femtosecond laser anterior capsulotomy is the first-line treatment for anterior capsular phimosis, with pre-procedure requirements including ensuring the eye is inflammation-free and confirming IOL stability 1, 2, 3, 6
Post-procedure monitoring should include monitoring IOP in the early postoperative period, especially in high-risk patients, and considering prophylactic IOP-lowering agents in patients with pre-existing glaucoma 1, 2, 3, 4

Anterior capsule polishing during initial cataract surgery may reduce the incidence of anterior capsular phimosis, but should be avoided if posterior capsule rupture occurs 1, 2, 3, 6

Complications of laser anterior capsulotomy include increased IOP, retinal detachment, retinal tear, cystoid macular edema, and persistent floaters 1, 2, 3, 4, 5, 6
Patient education is critical, with high-risk patients needing to be educated about symptoms of retinal tears or detachment to facilitate early diagnosis 1, 2, 3, 5