[Complete occlusion of the frontal capsule after cataract-operation in a patient with pseudoexfoliation syndrome--a case report and review of literature].
BACKGROUND
Pseudoexfoliation syndrome (PEX) is associated with an increased risk for the development of capsular fibrosis including capsular phimosis. A complete occlusion of the anterior capsular opening is, so far, a rarely reported phenomenon.


METHODS
Here we report the case of a 75-year-old female patient who suffered from a secondary open-angle glaucoma caused by PEX. Three months after an uneventful cataract surgery with capsulorhexis, phakoemulsification and implantation of a posterior chamber lens (PMMA) the anterior capsular opening of her left eye was completely occluded.


RESULTS
The patient reported a slow loss of vision (20/40 immediately after cataract surgery to 20/200 at the follow-up visit three months later). The examination revealed a complete closure of the capsulorhexis with thick, central fibrous material. The diameter of the capsulorhexis was extensively diminished. Reopening of the anterior capsular opening utilizing a YAG laser was achieved and visual acuity increased to 20/40. Additionally, the fibrotic, secondary cataract of the posterior capsule was removed, again with a YAG laser, five weeks after the first intervention and, now with a free optical axis, the patient's visual acuity increased further to 20/30.


CONCLUSIONS
The excessive production of fibrosis and the tendency towards a shrinkage of the diameter of the capsulorhexis postoperatively in patients with PEX may lead to a complete occlusion of the capsulorhexis. Even in such extreme cases, the reopening of the anterior and posterior capsule by a YAG laser is possible and, as demonstrated here, leads to a morphologically and functionally satisfying result.
Höhn
S
S
Universitäts-Augenklinik Ulm, Ulm. simone.hoehn@medizin.uni-ulm.de
Spraul
C W
CW
D000368:Aged; D019923:Capsulorhexis / Q000379:methods; D002387:Cataract Extraction / Q000009:adverse effects*; D017889:Exfoliation Syndrome / Q000150:complications* / Q000601:surgery*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000601:surgery*