A rare case of complete anterior capsular occlusion following phacoemulsification with acrylic intraocular lens and capsular tension ring implantation in pseudoexfoliation syndrome

A 72-year-old man presented with bilateral brunescent cataract with pseudoexfoliation syndrome and subtle phacodonesis. He underwent right eye phacoemulsification with a 5-mm continuous curvilinear capsulorrhexis and implantation of an acrylic hydrophilic intraocular lens (IOL) with a polymethyl methacrylate (PMMA) capsular tension ring (CTR). Six months postoperatively, anterior capsule fibrosis and complete closure of the capsulorhexis opening were noted. A neodymium: YAG (Nd: YAG) laser anterior capsulotomy was performed for visual recovery. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR in patients with pseudoexfoliation. Such patients must be frequently monitored postoperatively. A Nd: YAG laser anterior capsulotomy is a safe and effective option to manage even thick membranous anterior capsular occlusion. This is a unique case report since anterior capsular fibrosis and complete occlusion despite CTR in situ are extremely rare (reported only once to the best of our knowledge).