What are the symptoms, diagnosis, and treatment options for anterior capsular phimosis in an older adult with a history of cataract surgery?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 4, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Anterior Capsular Phimosis: Clinical Management

Anterior capsular phimosis (also called anterior capsular contraction syndrome) should be treated with Nd:YAG or femtosecond laser anterior capsulotomy when it causes decreased visual acuity, IOL decentration, or IOL tilt. 1

Pathophysiology and Risk Factors

Anterior capsular phimosis is caused by metaplastic lens epithelial cells leading to fibrosis and progressive shrinkage of the anterior capsular opening. 1

High-risk conditions include: 1

  • Pseudoexfoliation syndrome
  • Retinitis pigmentosa
  • Diabetes mellitus
  • Uveitis
  • Eyes with zonular pathology
  • Silicone IOL optic materials (higher risk than acrylic)

Clinical Presentation

Symptoms: 1, 2, 3

  • Progressive blurred vision
  • Decreased visual acuity
  • Visual distortion or metamorphopsia in severe cases

Signs on examination: 1, 2, 4, 3, 5

  • Central anterior capsular opacification
  • Visible shrinkage of the anterior capsular opening
  • IOL decentration or tilt
  • Haptic deformation or folding onto the optic (in severe cases)
  • Fibrous membrane formation occluding the visual axis (in pseudoexfoliation patients)
  • IOL dislocation in extreme cases

Diagnostic Approach

Slit-lamp examination findings: 3, 5

  • Co-axial retro-illumination reveals capsular scarring and contraction
  • Assessment of IOL position and stability
  • Evaluation of anterior chamber inflammation

Anterior segment optical coherence tomography (ASOCT) can confirm the diagnosis and assess severity of capsular contraction and IOL deformation. 3, 5

Fundus examination may be difficult due to media haze from capsular scarring but should be attempted to rule out posterior segment pathology. 3

Treatment Algorithm

Primary Treatment: Laser Capsulotomy

Nd:YAG or femtosecond laser anterior capsulotomy is the first-line treatment for anterior capsular phimosis. 1

Pre-procedure requirements: 1, 6

  • Ensure the eye is inflammation-free
  • Confirm IOL stability
  • Assess for risk factors (glaucoma, axial myopia, vitreoretinal disease)

Post-procedure monitoring: 1

  • Monitor IOP in the early postoperative period, especially in high-risk patients
  • Consider prophylactic IOP-lowering agents in patients with pre-existing glaucoma
  • Treatment with topical corticosteroid, NSAID, ocular hypotensive, or cycloplegic agents depends on patient risk factors

Alternative Surgical Technique

For cases requiring vitreoretinal surgery or when laser capsulotomy is insufficient, a surgical approach using fine pointed scissors to cut the anterior capsule radially toward the optic edge, followed by capsulorrhexis forceps to tear away the anterior capsule, has been described as effective. 2

Severe Cases Requiring IOL Exchange

In cases of severe capsular bag phimosis with significant IOL deformation that would result in severe image distortion, metamorphopsia, and aniseikonia even after YAG capsulotomy, IOL explantation with the phimosed capsular bag and placement of a scleral-fixated IOL may be necessary. 3

Prevention Strategies

Anterior capsule polishing during initial cataract surgery may reduce the incidence of anterior capsular phimosis. 1

However, avoid anterior capsule polishing if posterior capsule rupture occurs, as this may destabilize remaining capsular support. 7

Important Complications and Patient Education

Complications of laser anterior capsulotomy include: 1

  • Increased IOP (most common)
  • Retinal detachment (0.87% risk in first 5 months)
  • Retinal tear (0.29% risk in first 5 months)
  • Cystoid macular edema
  • IOL damage or dislocation
  • Persistent floaters

Patient education is critical: 1, 6

  • Educate high-risk patients about symptoms of retinal tears or detachment (new floaters, flashes, visual field defects) to facilitate early diagnosis
  • Eyes with axial length less than 24.0 mm have shown 0% incidence of retinal detachment in case series

Clinical Outcomes

YAG laser anterior capsulotomy leads to good visual outcomes with low complication rates, with studies showing comparable results whether performed by experienced ophthalmologists or appropriately trained advanced practitioners. 8

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Capsular bag phimosis.

American journal of ophthalmology case reports, 2020

6
Guideline

YAG Laser Capsulotomy Indications and Considerations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

7
Guideline

Management of Posterior Capsule Rupture During Phacoemulsification

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What are the potential complications of measles in children, particularly those under 5 years old with weakened immune systems, such as Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) or undergoing chemotherapy?
What is the recommended dose of enoxaparin (low molecular weight heparin) for a 130kg patient with pulmonary embolism and lung infarct?
What is the management approach for an adult patient with hepatitis?
Where are atypical round cell neoplasms, such as Ewing's sarcoma, typically found in pediatric patients?
What is the efficacy of dry needling (DN) for treating chronic pain in patients who have not responded to other therapies, such as physical therapy, medication management, or acupuncture?
What does an abnormal Urine Albumin-to-Creatinine Ratio (UACR) indicate in a patient, possibly with diabetes or hypertension?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question