ANTERIOR BILATERALE CAPSULOPHIMOSIS

Anterior capsular phimosis is the centripetal fibrosis and contraction of the capsulorhexis after cataract extraction. Individuals with zonular laxity are at increased risk for this condition. Mild to moderate amounts of phimosis are usually not visually significant, but severe cases may require treatment by Nd:YAG laser anterior capsulotomy.

we report a case of a child with a progressive deterioration of vision bilateral

We report a case of a 9 year-old child, who underwent cataract surgery for congenital
cataract bilateral, with posterior capsulorhexis and intraocular lens implantation, In the immediate , the patient recovered, for each eye, a visual acuity of 20/40 . The patient REPORTS with   9  months of gradually progressive deterioration of vision bilateral . at the ophthalmological examination visual acuity 20/400 ,capsule contraction syndrome on 360° degrees bilateral , with a clear visual axis.the treatment  is by Nd: YAG laser anterior capsulotomy

The first clinical description of anterior capsular phimosis was in 1993 by Davison .Anterior capsule contraction syndrome is thought to result from metaplastic lens epithelial cells (LECs) which undergo differentiation into fiber-like cells causing constriction and obstruction of the visual axis . A report analyzed the capsular phimosis membrane which showed the composition of fibrous tissue interspersed with cells that resembled fibrocytes with elongated nuclei representing metaplasia of LECs . Previous studies have reported that anterior capsulophimosis may lead to some complications as intraocular lens displacement. They have reported also that the treatment of severe cases is by Nd: YAG laser anterior capsulotomy . Laser treatment has been shown to prevent the progression of the contraction using 3 or more nicks around the capsular annulus . In severe or Nd:YAG laser-resistant cases, surgery with microscissors to cut the fibrotic membrane is considered.

The preparations and actions that will best help surgeons avoid capsular contraction syndrome include knowledge of the syndrome, awareness of high-risk conditions, selection of the appropriate IOL, segments, and suture placement, meticulous surgery including capsular lens epithelial cell cleanup, and vigilant observation of the patient for early detection and intervention.