Сapsular bag contraction syndrome and its prevention

Capsular bag contraction syndrome, also known as anterior capsule contraction syndrome or capsular phimosis, is a phacoemulsification complication. This condition is characterized by capsular wrinkling, intraocular lens decentration or tilt, and considerably decreased vision. Some publications describe its pathogenesis based on the cellular theory of proliferation, migration, and differentiation of residual lens epithelial cells. This article provides the most common manifestations of capsular bag contraction syndrome, its causes, current classifications, and prevention and treatment options. Its risk factors are discussed based on the surgical technique, the material and shape of intraocular lenses, comorbidities, and patient’s age. The article also discusses prevention methods affecting both the reduction of the centripetal forces of the capsulorhexis edges and the increase in the centrifugal forces of the zonular fiber. Advantages and disadvantages of each method are described using clinical examples and published data. It has been demonstrated that combined methods to prevent capsular bag contraction syndrome, aimed simultaneously at various pathogenesis events, are the most effective. The author’s technique is proposed. It includes implantation of two capsular tension rings into the capsular bag and fixed to the iris and longitudinal capsulotomy. One capsular tension ring may be implanted into the capsular bag and fixed to the iris. This technique allows for not only completely eliminating centripetal effects using incisions of the capsulorhexis edge, but also creating a uniform circular tension of the capsule bag equator. Moreover, prevention of capsular bag contraction by reducing its diameter is expected to be ensured by the proximal edges of the capsular tension ring placed into the ciliary sulcus. This mechanism also reduces the pathological mobility of the capsular bag caused by inertial globe movements.