Rapid Anterior Capsular Contraction After Femtosecond Laser–Assisted Cataract Surgery In A Patient With Fuchs Corneal Dystrophy

To report a case of rapid and severe anterior capsular contraction (ACC) occurring within one months after femtosecond laser–assisted cataract surgery (FLACS) in a patient with Fuchs corneal dystrophy (FCD), and to discuss possible mechanisms, risk factors, and clinical implications.

A case report conducted at a tertiary referral center in Taiwan.

A 71-year-old female with FCD underwent uneventful FLACS in the left eye for age-related nuclear sclerosis. Preoperative examination revealed bilateral corneal guttae with quiet anterior chambers and no history of ocular or systemic disease. A femtosecond laser–created continuous curvilinear capsulotomy with a planned diameter of 5.2 mm was performed. Postoperatively, topical levofloxacin ophthalmic solution 0.5% and neomycin–betamethasone ophthalmic ointment were prescribed with gradual tapering. No early postoperative inflammation or complications were observed.

Initial postoperative recovery was unremarkable, with best-corrected visual acuity improving from 0.03 to 0.6. However, within one month after surgery, rapid and severe ACC developed, resulting in a residual capsular opening of approximately 2 mm despite stable intraocular lens centration and minimal anterior chamber inflammation. Automated keratometry was unobtainable because of capsular phimosis. Corneal status remained stable without progression of endothelial decompensation on serial specular microscopy. Neodymium:yttrium–aluminum–garnet (Nd:YAG) laser anterior capsulotomy was recommended but declined because of satisfactory subjective visual function, presumably related to a pinhole effect.

ACC is a not common but potentially vision-threatening complication after cataract surgery, with reported incidences of approximately 1.4% to 14%. Established risk factors include pseudoexfoliation syndrome, uveitis, retinitis pigmentosa, high myopia, small capsulorhexis size, and zonular weakness. Although FLACS generally provides precise and reproducible capsulotomy, studies have reported no increased overall incidence but occasional early or exaggerated contraction in high-risk eyes. Patients with FCD may be predisposed to accelerated capsular fibrosis because of an altered inflammatory and profibrotic tendency. This case highlights the need for careful postoperative surveillance and prompt management in high-risk patients.