Capsular phimosis

A 59-year-old female patient came to the OPD with complaints of diminution of vision in the left eye (OS) since 1 month. The best-corrected visual acuity was 6/24 in the right eye (OD) and 6/24 part in the left eye. GAT IOP was 29 and 50 mmHg. On examination, anterior segment OD showed NS II cataract and shallow AC. OS showed shallow AC with mid-dilated pupil 6 mm, NS II cataract with phacodonesis. Posterior segment examination showed a CD ratio of 0.5:1 in OD and 0.6:1 in OS with asteroid hyalosis. Synechial angle closure was seen in both eyes on gonioscopy. A diagnosis of OD PAC and OS IMSC with PACG was made. IV Mannitol 300 mL infusion was given stat followed by OU YAG peripheral iridectomy under topical anesthesia followed by OS phacoemulsification + IOL implantation, and was called for regular follow-ups. On 1-month follow-up, OS capsular phimosis was seen in the patient. Imparting a bluish hue, this case of capsular phimosis was a hole-in-one! Slit-lamp examination findings of OS are given in Fig. 1.Figure 1: Slit-lamp photograph of capsular phimosis with bluish hueDiscussion Capsular phimosis is associated with conditions that increase inflammation in the anterior chamber or lead to blood-aqueous barrier instability such as pseudoexfoliation, uveitis, myotonic dystrophy, retinitis pigmentosa, diabetic retinopathy, high myopia, and Marfan’s syndrome. Surgical risk factors such as small capsulorhexis size and insufficient aspiration of residual lens epithelial cells, excessive manipulation leading to or due to zonular dehiscence, or phacodonesis may also lead to capsular phimosis which may benefit with implantation of capsule tension ring.[1] It is more common in a small-size anterior capsule opening in patients with weak zonules.[2] Nd: YAG capsulotomy is effective and safe in treating anterior capsular phimosis in patients as an early intervention.[3] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.