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Anterior Capsular Phimosis Occluding the Capsulorhexis Opening after Cataract Surgery in a Diabetic Patient with High Hemoglobin A1C

ABSTRACT Purpose: To report a case of complete occlusion of the capsulorhexis opening in a DM patient with high hemoglobin A1C level. Methods: A 77-year-old woman with non-insulin-dependent diabetes underwent uncomplicated phacoemulsification in both eyes. One year later, she presented again because of reduced vision (best-corrected visual acuity of 16/20 in the right eye, 6/20 in the left eye). Dilated examination revealed marked anterior capsular contraction in the right eye and anterior capsular phimosis totally occluding the capsulorhexis opening in the left eye. Results: The severity of diabetic retinopathy and her fasting blood sugar (225 mg/dl) and hemoglobin A1C level (8.5%) increased during the previous year. Uncorrected visual acuity of 18/20 (OS) was achieved after a neodymium:YAG (Nd:YAG) radial anterior capsulotomy was performed. Conclusion: Microvascular complications such as diabetic retinopathy or diabetic iritis can occur in patient with uncontrolled diabetes mellitus. The pathophysiology of anterior capsular phimosis in this patient is probably increased vascular permeability chronically associated with diabetes.