Background: Anterior capsular phimosis is a fibrotic complication of cataract surgery caused by myofibroblastic metaplasia of residual lens epithelial cells and centripetal contraction of the capsulorrhexis. It is aggravated by small rhexis, pseudoexfoliation, retinitis pigmentosa, and pathological high myopia. Severe phimosis can impair vision, decenter or dislocate the Intraocular lens (IOL)—particularly in monocular, high-myopic patients. 1-4 Purpose: To detail a reproducible microsurgical technique for releasing dense anterior capsular phimosis in a monocular, pathologically myopic eye, where Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser was contraindicated due to dense fibrosis and risk of IOL optic pitting. Synopsis: A 50-yearold man with axial myopia (−12 D) and monocular status presented three years after uneventful phacoemulsification with progressive visual decline. Slit-lamp examination showed a fibrotic, constricted anterior capsular opening (~2 mm) and an oval rhexis. To avoid IOL pitting and zonular stress from YAG capsulotomy, we performed microsurgical capsulotomy via a bimanual approach. Curved intravitreal scissors created multiple radial relaxing incisions; fibrotic flaps were then Excised Video. At three months, best-corrected visual acuity improved from hand motions to finger counting at 1 m, with a stable, well-centered IOL and no recurrence. Fundus exam confirmed underlying myopic maculopathy with diffuse chorioretinal atrophy. Highlights: First step-by-step video of microsurgical capsular phimosis release (with easily available microforceps and microscissors) in a monocular, high-myopic eye. Avoidance of the YAG laser in dense fibrosis to protect IOL optics and zonules. Application of microforceps for capsular leaflet excision to avoid zonular stress. 5 Video Link: https://youtu.be/RccBhm6wiKY
Shah et al. (Wed,) studied this question.