Management Of Severe Capsular Contraction Syndrome In A Microphthalmic Eye With Iris Coloboma: Iol Explantation And Secondary Yamane Scleral Fixation With Pupilloplasty

To present the surgical management of severe capsular contraction syndrome with a decentered bag–IOL complex in a microphthalmic eye with iris coloboma, requiring intraoperative strategy modification and secondary scleral fixation.

Hazem Yassin International Cornea Center

A 45-year-old female presented with progressive visual deterioration 18 months after uncomplicated phacoemulsification. Examination revealed severe anterior capsular phimosis (~3 mm fibrosed capsulorhexis), peripheral capsular fibrosis, decentered bag–IOL complex, and pre-existing inferior iris coloboma in a microphthalmic eye.

Surgical management aimed to preserve the capsular bag and implant a secondary IOL in-the-bag. Mechanical pupil expansion required combined iris hooks and Malyugin ring due to abnormal iris anatomy. Capsular hooks were used to centralize the shifted bag.

During capsular polishing, capsular extension occurred, necessitating abandonment of the in-the-bag approach. The IOL was explanted following complex entanglement with expansion devices. A 3-piece IOL was implanted using the Yamane double-needle scleral fixation technique. Partial posterior displacement of the IOL occurred intraoperatively and was successfully rescued. Pupilloplasty was performed to reconstruct the coloboma.

Severe capsular contraction in microphthalmic eyes creates an unstable intraoperative setting.Prolonged attempts to preserve the capsular bag amid progressive zonular failure heighten posterior segment risk and erode surgical control.Early recognition of capsular compromise and prompt conversion to scleral fixation permit controlled reconstruction and safer outcomes. In anatomically constrained eyes, expansion devices and capsular stabilization may improve exposure but they must not delay reassessment once structural integrity is lost.The Yamane technique offers reproducible minimally invasive solution when support is unsalvageable and with pupilloplasty enables comprehensive anterior segment rehabilitation restoring centration and balance.