Anterior segment optical coherence tomography-guided management of capsular contraction and anterior–posterior capsular adhesion after congenital cataract surgery: a case report

Capsular changes after congenital cataract surgery may compromise the visual axis in infants and may necessitate secondary surgical intervention. In such situations, identifying a safe dissection plane can be challenging under conventional microscopic visualization, and adjunctive intraoperative imaging may be beneficial. A 2-month-old boy diagnosed with bilateral congenital cataracts underwent phacoaspiration, posterior capsulotomy, and anterior vitrectomy with planned aphakia. Despite continued topical treatment, the patient developed progressive posterior synechiae, anterior capsular contraction, and anterior–posterior capsular adhesion within 1 month postoperatively. Surgical dissection of the adhesion and enlargement of the anterior capsulotomy were performed under intraoperative anterior segment optical coherence tomography (AS-OCT) guidance. AS-OCT provided intraoperative cross-sectional information suggesting a narrow cleavage plane between the anterior and posterior capsules, which helped guide targeted viscodissection. Intraoperative AS-OCT may serve as a useful adjunct in the management of postoperative capsular adhesion after congenital cataract surgery by helping surgeons identify the dissection plane and guide intraoperative decision-making, particularly when conventional microscopic visualization is limited.