Anterior capsular phimosis following cataract surgery: AS-OCT features and Nd:YAG laser management

Anterior capsular phimosis is a well-known postoperative complication of cataract surgery, characterised by progressive constriction of the capsulorhexis opening due to fibrotic changes in the anterior capsule. We report a case of a 62-year-old male who presented with decreased vision in the left eye 6 weeks after undergoing cataract surgery with intraocular lens (IOL) implantation and capsular tension ring insertion. There was an oval-shaped anterior capsular phimosis with temporal haptic flexion of the IOL, along with posterior capsular opacification and wrinkling of the anterior capsule. Anterior segment optical coherence tomography (AS-OCT) showed a thick subcapsular fibrosis extending to the anterior surface after crossing the anterior capsular margin. Neodymium: yttrium-aluminum-garnet laser anterior capsular lysis was performed at four clock positions. One week after the procedure, exaggerated fibrosis was observed at the laser sites, which subsequently stabilised without any IOL decentration over a 4-month follow-up period. The final best-corrected visual acuity improved to 6/9. This case highlights anterior capsular phimosis, with AS-OCT imaging demonstrating subcapsular fibrosis that causes anterior capsule undulations and extends across the capsular edge onto the anterior capsule surface, along with the treatment response.