Anterior Capsulorhexis Optic Capture for Zonular Insufficiency: Three-Year Outcomes With a Retinitis Pigmentosa Subanalysis

PURPOSE: To evaluate 3-year visual, refractive, and anterior segment optical coherence tomography (AS-OCT)-measured intraocular lens (IOL) positional stability after anterior capsulorhexis optic capture (ACOC) in eyes with zonular insufficiency, with secondary assessment of capsulorhexis contraction in retinitis pigmentosa (RP). SETTING: University hospital, Japan. DESIGN: Retrospective case series. METHODS: Among 239 patients (311 eyes) undergoing ACOC, 7 eyes (2.3%) developed spontaneous loss of optic capture; these events were reported as safety events, and the primary longitudinal analysis included 304 eyes with maintained capture. Corrected distance visual acuity (CDVA), absolute refractive prediction error, IOL tilt and decentration, intraocular pressure (IOP), endothelial cell density (ECD) loss, complications, and capsulorhexis minor-axis ratio in RP eyes were assessed through 36 months. RESULTS: CDVA improved and stabilized after 3 months. Absolute refractive prediction error remained stable between 3 and 36 months (0.43-0.50 D). AS-OCT-measured IOL tilt and decentration remained stable from 3 to 36 months. In RP eyes, the minor-axis ratio was 0.92 ± 0.05 at 3 months and 0.96 ± 0.04 at 24 months, with no progression beyond 3 months. IOP at 36 months did not differ significantly from baseline, and ECD loss remained stable from 3 to 36 months. Capsular block syndrome (CBS) occurred in 218 eyes (71.7%); 210 underwent Nd:YAG posterior capsulotomy for CBS. Serious complications were infrequent. CONCLUSIONS: ACOC was associated with stable visual, refractive, and anatomical outcomes for up to 3 years in eyes with maintained optic capture. In high-risk RP eyes, progressive capsulorhexis contraction was not observed beyond 3 months.