Clinicopathologic correlation of capsulorhexis phimosis with anterior flexing of single-piece hydrophilic acrylic intraocular lens haptics

We describe 2 cases in which patients with 4-looped single-piece hydrophilic acrylic intraocular lenses (IOLs) exhibited postoperative complications including capsulorhexis phimosis. decentration, tilt, hyperopic shift, and luxation leading to explantation of the IOL capsular bag complex. The excessive capsule fibrosis led to anterior flexing of the IOL haptics in both cases, even in the presence of a capsular tension ring (CTR). Histopathological analyses revealed a thick fibrocellular tissue attached to the inner surface of the anterior capsules, corresponding to the anterior capsule opacification and folds An amorphous substance was observed on the outer surface of the anterior capsule in the case with a CTR, suggesting pseudoexfoliation material These and similar cases raise concerns about the postoperative behavior of highly flexible IOLs in the presence of excessive capsular bag fibrosis