Capsular bag phimosis

A 60year old male presented with insidious onset, gradually progressive, painless diminution of vision in the right eye since a year. He was operated for cataract about 7 years ago. However, details of surgery or intraocular lens (IOL) were unavailable. Fellow eye was unremarkable. Examination revealed a visual acuity of FC at 5 mts. Slit-lamp examination revealed a quiet anterior chamber without any cells-flare nor any posterior synechiae. Co-axial retro-illumination revealed an in-the-bag IOL, having both haptics folded on the optic with scarring and contraction of the capsular bag, most apparent in the centre. Fundus examination with indirect ophthamoloscopy was difficult owing to the media haze due to capsular scarring but retina was unremarkable as far as could be seen. A diagnosis of “Capsular Bag Phimosis”1,2,3,4 was made. An ASOCT demonstrated such severe moulding of the IOL that a simple YAG capsulotomy may have increased visual acuity but would have lead to severe image distortion, metamorphopsia and resultant aniseikonia. IOL was explanted alongwith the phimosed capsular bag and a Scleral-fixated IOL was placed to achieve a final BCVA 20/20P Snellen.