Role of Neodymium Yttrium Aluminum Garnet Capsulotomy in Anterior Capsular Phimosis-A Case Report

Capsule contraction syndrome is an exaggerated reduction in anterior capsulectomy and capsular bag diameter after cataract surgery. It is particularly common in patients with pseudoexfoliation and in eyes with a history of uveitis, myotonic dystrophy, and retinitis pigmentosa. Its effects, which include extreme reduction in the capsulectomy opening, malposition of the opening, reduction in equatorial capsular diameter, and displacement of the intraocular lens (IOL), seem more exaggerated in small capsulorhexis openings. We report a case operated for cataract elsewhere who had developed capsular phimosis and was successfully treated with Neodymium doped Yttrium Aluminum Garnet Capsulotomy. In this, the laser radial anterior capsulotomies were done which relieved the contraction forces within the bag and thereby improving the vision of the patient. Examination revealed a best-corrected visual acuity (BCVA) of finger counting at 4 m with 3 mm phimosis. Slit-lamp examination revealed a quiet anterior chamber without any cells-flare nor any posterior synechiae, but the IOL seemed tilted due to contraction forces and the fellow eye examination had pseudoexfoliation with both eyes normal fundus study. A four-petal Nd:YAG Capsultomy with four laser shots of 0.5 mJ was done with no surgical intervention, and proved a useful management protocol with the patient improving to BCVA 6/18 in less severe cases of phimosis. A prophylactic preventive measure is to do radial nicks after IOL implantation and/or a capsular tension ring (CTR) can also place in the fellow eye if phimosis is noted in the first eye and it is our institute policy to put a CTR in retinitis pigmentosa cases to prevent contraction of the bag and phimosis which is indeed a take-home message.