Bilateral anterior capsular phimosis in an 85-year-old female patient after stand-alone cataract extraction with intraocular lens implantation

Introduction: Anterior capsular phimosis is a rare complication after cataract extraction with intraocular lens implantation. Patient and clinical findings: An 85-year-old female underwent manual phacoemulsification with toric intraocular lens implantation in the right eye (OD) without any post-operative complications. Approximately 1.5 weeks later, she had the same procedure in the left eye (OS) with similar success. At post-operative week 6 OD and week 4 OS, distance visual acuity without correction was 20/400 OD and hand motion (HM) OS. Anterior segment examination revealed intraocular lens implants with a significant fibrotic anterior capsule in both eyes. Posterior segment examination showed pigmentary macular changes in both eyes that were unchanged from the pre-operative evaluation. Diagnosis, intervention, and outcomes: The patient was diagnosed with bilateral anterior capsular phimosis. She underwent Nd:YAG laser capsulotomy in the left eye, then in the right eye 1 week later. At Nd: YAG laser capsulotomy post-operative day 4 OD and week 2 OS, distance visual acuity without correction was 20/40 OD, OS with best corrected visual acuity 20/30 OD, OS. Conclusions: Anterior capsular phimosis can occur in both eyes sooner than 4 weeks after cataract extraction with intraocular lens implantation in a patient with no risk factors.