We report the case of a patient with retinitis pigmentosa, zonular weakness, and diabetes mellitus who underwent bilateral cataract surgery. One month after surgery in the right eye, the patient developed complete anterior capsular contraction associated with decreased visual acuity and inferior IOL displacement, requiring early Nd:YAG laser capsulotomy. Based on the postoperative findings in the first eye, preventive intraoperative measures were implemented during cataract surgery in the second eye, including creation of a large capsulorhexis, meticulous anterior capsule polishing, and implantation of a capsular tension ring. Postoperatively, the second eye developed mild capsulophimosis, markedly less severe than the fellow eye.
Association Between Retinitis Pigmentosa And Anterior Capsular Contraction: Surgical Strategies To Prevent This Complication
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT159 | Type: Poster | DOI: 10.82333/z627-wp82
Authors: Dr Alicia Garde Gonzalez* 1 , Dr Julio Ruiz Batres 1 , Dr Rosa Gutierrez Bonet 1 , Dr Nicolas Lopez Ferrando 1 , Dr Jacobo Yañez 1 , Dr Lucia Ibares 1 , Dr Blanca García Valcarcel 1 , Dr Javier Torresano 1
1Hospital Gregorio Marañon,Madrid,Spain
Purpose
Progressive anterior capsular contraction following cataract surgery is a well-recognized complication in patients with retinitis pigmentosa (RP), with a significantly higher incidence compared with the general population. This phenomenon has been attributed to zonular weakness and the enhanced fibrotic response characteristic of RP, which in some cases may lead to intraocular lens (IOL) decentration or dislocation. Awareness of surgical strategies that may reduce this risk is therefore essential.
Setting
Case report of a patient with retinitis pigmentosa, zonular weakness, and diabetes mellitus undergoing bilateral cataract surgery, with postoperative follow-up and comparative outcomes between both eyes.
Methods
Results
The use of capsular tension rings in patients with RP may reduce, but does not completely eliminate, the risk of capsulophimosis; significant capsular contraction has been reported even in eyes with implanted tension ring. Preventive intraoperative strategies include performing a well-centered, regular capsulorhexis measuring at least 5.5–6.0 mm, together with meticulous removal of residual subcapsular lens epithelial cells to minimize postoperative fibrotic proliferation.
In our case, modification of the surgical approach in the second eye resulted in a markedly improved outcome, with better visual acuity and stable IOL positioning.
Conclusions
Patients with RP presenting additional risk factors, such as zonular weakness, pseudoexfoliation syndrome, diabetes mellitus, uveitis, or anatomical alterations of the capsular bag, are more likely to develop postoperative capsulophimosis. Furthermore, advanced stages of RP confer higher risk of capsular contraction and IOL dislocation.
This case highlights the importance of recognizing the association between RP and capsulophimosis to tailor surgical technique in these patients and reduce future complications. Adequate capsulorhexis sizing, anterior capsule polishing, and capsular tension ring implantation may significantly reduce the risk of postoperative capsular contraction and IOL displacement.