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Dear Sir, I am Dr Zong-Duan Zhang, from the Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province, China. I write to present a case report of bilateral capsule contraction syndrome (CCS). CCS is a well-recognized postoperative complication of cataract surgery which occurs predominantly after continuous curvilinear capsulorhexis (CCC) [1]. It comprises capsule opacification, capsulorhexis shrinkage and secondary intraocular lens (IOL) deformation, decentration and tilt. Effectiveness of the Neodymium:YAG (Nd:YAG) laser treatment to this postoperative complication has been confirmed. We reported a case of CCS with both anterior and posterior capsular shrinkage after implantation of IOL with relatively high stability performance, and treated with both anterior and posterior capsulotomy using Nd:YAG laser. To our knowledge, this is the first described case of bilateral CCS with both anterior and posterior capsule shrinkage after a single-piece hydrophilic acrylic IOL (Akreos Adapt) implantation that successfully treated anterior and posterior capsulotomy with Nd:YAG laser. A 55-year-old woman with pathological myopia in both eyes underwent uneventful phacoemulsification cataract extraction in the left eye. A CCC of 5.0 mm diameter was performed followed by in-the-bag implantation of a +6.0D Akreos Adapt (Bausch&Lomb) IOL. Routine phacoemulsification and in-the-bag implantation of a +9.0 D IOL with the same type was performed in the right eye. The immediate postoperative period was uneventful. After 2 months, the uncorrected distance visual acuity (UDVA) was 20/160 (OD) and 20/125 (OS), and the CDVA was 20/100 with -2.25-2.00 伊115 (OD) and 20/40 with -2.25-1.75 伊75 (OS). One year postoperatively, the corrected distance visual acuity(CDVA) decreased to 20/125(OD) and 20/500 (OS). Clinical examination showed significant bilateral anterior capsule opacification (ACO) and posterior capsule opacification (PCO)and shrinkage of the capsular bags. The capsulorhexis opening appeared to be fibrous metaplasia, and there were multiple capsular bag folds of both anterior and posterior capsules. In the left eye, decentration and tilt of the IOL was noted. One of the 4 closed loops at 2 o'clock position appeared to be flexed anteriorly within the capsular bag in association with capsular fibrosis, more prominent at the corresponding side (Figure 1A,B). Similar changes were observed in the right eye with flexed haptic at the 10 o'clock position (Figure 1C). Radial relaxing capsulotomy of the anterior capsule and circular capsulotomy of the posterior capsule with Nd:YAG laser was performed in both eyes. Radial incision was carried out at the most prominent segment. The treatment reduced the displacing force of the contracting capsule on the IOL and relieved traction on the zonules in the mostly affected segment, resulting in stabilization and recentering of the IOL (Figure 1D, E, F). The CDVA increased to 20/100 (OD) and 20/40 (OS). CCS is associated with ocular pathologies which can compromise blood-aqueous barrier, including pseudoexfoliation syndrome, retinitis pigmentosa, advanced age, high myopia, myotonic muscular dystrophy and uveitis . The fact that the patient in this case had advanced age and high myopia might account for this postoperative complication. The CCC has been proposed to be a predisposing factor of CCS in the light of the size and shape of the opening. CCC has been confirmed to be associated with contraction of capsulorhexis opening much higher than can-opener Bilateral CCS following myopic cataract surgeries

Bilateral capsule contraction syndrome following pathological myopic cataract surgeries.