Clinical case of visual axis opacification after primary posterior capsulorhexis

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


The formation of posterior continuous capsulorhexis during cataract removal has traditionally been used to prevent visual axis opacification. According to the current literature, closure of the posterior capsulorhexis opening in our patient's case should not have developed in a period of 1 year, but it did in only one of the two eyes, despite the presence of equal conditions — the same surgeon, the same IOL (sharp-edged hydrophilic acrylic with hydrophobic coating), no concomitant eye diseases and somatic pathology. We conducted a literature search to find the cause of the unilateral development of this complication, as well as the optimal treatment method. The difference between two surgeries was in the diameter of the anterior and posterior capsulorhexis — on the right eye they were 0.5–1.0 mm larger than on the left eye, and the left eye has developed opacity, which required surgery. An effective and safe way of treating this problem is the capsulotomy using a 25 gauge-vitreotome. The clinical case shows the need for further research on this topic, as formation of posterior continuous capsulorhexis has a risk of intra- and postoperative complications, and more data should be considered to ensure that there is no such recurrence of opacity.

Full Text

Restricted Access

About the authors

Iuliia V. Bantsykina

Samara State Medical University

Author for correspondence.
ORCID iD: 0000-0003-3524-2328

PhD Stud., Depart. of Eye Diseases

Russian Federation, Samara, Russia

Igor V. Malov

Samara State Medical University

ORCID iD: 0000-0003-2874-9585

M.D., D. Sci. (Med.), Prof., Head of Depart. of Eye Diseases

Russian Federation, Samara, Russia

Irina I. Shteyner

Regional Medical Center

ORCID iD: 0000-0001-5891-6255

M.D., Cand. Sci. (Med.), Ophthalmologist

Russian Federation, Samara, Russia


  1. Yu M, Yan D, Wu W, Wang Y, Wu X. Clinical outcomes of primary posterior continuous curvilinear capsulorhexis in postvitrectomy cataract eyes. J Ophthalmol. 2020;2020:6287274. doi: 10.1155/2020/6287274.
  2. Yazici AT, Bozkurt E, Kara N, Yildirim Y, Demirok A, Yilmaz OF. Long-term results of phacoemulsification combined with primary posterior curvilinear capsulorhexis in adults. Middle East Afr J Ophthalmol. 2012;19(1):115–119. doi: 10.4103/0974-9233.92126.
  3. Nikolashin SI, Yablokov MM. The primary posterior capsulorhexis. Literary review. Tambov University reports. Series: natural and technical sciences. 2016;(1):194–198. (In Russ.) doi: 10.20310/1810-0198-2016-21-1-194-1.
  4. Kovalevskaya MA, Filina LA, Kokorev VL. Factors of the risk of developing a secondary cataract and recommendations for conducting a primary posterior capsulorhexis. Bulletin of experimental and clinical surgery. 2018;11(3):213–217. (In Russ.) doi: 10.18499/2070-478X-2018-11-3-213-217.
  5. Gu X, Chen X, Jin G, Wang L, Zhang E, Wang W, Liu Z, Luo L. Early-onset posterior capsule opacification: Incidence, severity, and risk factors. Ophthalmol Ther. 2022;11(1):113–123. doi: 10.1007/s40123-021-00408-4.
  6. Yu M, Huang Y, Wang Y, Xiao S, Wu X, Wu W. Three-dimensional assessment of posterior capsule-intraocular lens interaction with and without primary posterior capsulorrhexis: an intraindividual randomized trial. Eye (Lond). 2021;10.1038/s41433-021-01815-4. doi: 10.1038/s41433-021-01815-4.
  7. Egorova EV. Analysis of the results of OCT studies of the vitreolenticular interface after lens surgery with primary posterior capsulorhexis. In: Pathogenetically oriented technology of cataract surgery in pseudoexfoliation syndrome based on the study of the vitreolenticular interface. Novosibirsk: Russian ophthalmology online; 2020. p. 135–150. (In Russ.)
  8. Menapace R. Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases. Graefes Arch Clin Exp Ophthalmol. 2008;246(6):787–801. doi: 10.1007/s00417-008-0779-6.
  9. Shrestha UD, Shrestha MK. Visual axis opacification in children following paediatric cataract surgery. JNMA J Nepal Med Assoc. 2014;52(196):1024–1030. doi: 10.31729/jnma.2807.
  10. Toropygin SG, Glushkova EV. Secondary cataracts after in-the-bag intraocular lens implantation: risk factors and ways of prevention (part 3). Russian Ophthalmological Journal. 2018;11(2):103–112. (In Russ.) doi: 10.21516/2072-0076-2018-11-2-103-112.
  11. Zhao Y, Yang K, Li J, Huang Y, Zhu S. Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery: An updated meta-analysis. Medicine (Baltimore). 2017;96(44):e8301. doi: 10.1097/MD.0000000000008301.
  12. Egorova EV, Druzhinin IB, Dulidova VV, Chernykh VV. Morphological features of secondary cataract after phacoemulsification with primary posterior capsulorhexis. Practicheskaya meditsina. 2017;(3):30–34. (In Russ.)
  13. Raj SM, Vasavada AR, Johar SR, Vasavada VA, Vasavada VA. Post-operative capsular opacification: a review. Int J Biomed Sci. 2007;3(4):237–250. PMID: 23675049.
  14. McAvoy J, Beebe DC. Lens epithelium and posterior capsular opacification. Tokyo Heidelberg New York Dordrecht London: Springer; 2014. 424 р. doi: 10.1007/978-4-431-54300-8.
  15. Nishi Y, Ikeda T, Nishi K, Mimura O. Epidemiological evaluation of YAG capsulotomy incidence for posterior capsule opacification in various intraocular lenses in Japanese eyes. Clin Ophthalmol. 2015;1(9):1613–1617. doi: 10.2147/OPTH.S89966.
  16. Lin H, Tan X, Lin Z, Chen J, Luo L, Wu X, Long E, Chen W, Liu Y. Capsular outcomes differ with capsulorhexis sizes after pediatric cataract surgery: A randomized controlled trial. Scientific reports. 2015;5:16227. doi: 10.1038/srep16227.
  17. Menapace R, Schriefl S, Lwowski C, Leydolt C. Impact of primary posterior capsulorhexis on regeneratory after-cataract and YAG laser rates with an acrylic micro-incision intraocular lens with plate haptics: 1-year and 3-year results. Acta Ophthalmol. 2019;97(8):e1130–e1135. doi: 10.1111/aos.14156.

Supplementary files

Supplementary Files
1. Fig. 1. Patient's right eye, posterior capsulorhexis, rounded. The optical zone is transparent

Download (10KB)
2. Fig. 2. Patient's left eye, posterior capsulorhexis, rounded. Elschnig cells on the back of the IOL

Download (16KB)
3. Fig. 3. Left eye of patient after surgical aspiration of Elschnig cells

Download (19KB)

© 2022 Eco-Vector

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies