Anterior Capsular Contraction Syndrome (ACCS)

Anterior Capsular Contraction Syndrome (ACCS) is a postoperative complication of cataract surgery characterized by the progressive constriction and fibrotic shrinkage of the anterior capsulotomy (the circular opening in the front capsule of the lens) that is created during phacoemulsification and intraocular lens (IOL) implantation. In a healthy eye, residual lens epithelial cells left behind after surgery remain quiescent, and the capsulorhexis opening may contract slightly without clinical consequence. In ACCS, however, these cells undergo metaplasia into myofibroblasts, produce excessive extracellular matrix, and generate contractile forces that pull the capsular opening centripetally, sometimes reducing it dramatically or even closing it entirely. This contraction typically develops within the first three to six months postoperatively and can lead to visual axis obstruction, hyperopic refractive shifts, IOL decentration or tilt, zonular stress, and in severe cases, dislocation of the entire capsular/IOL complex CRSTodayLippincott Journals.

Patients with ACCS may initially be asymptomatic, but as fibrosis progresses, they experience blurred vision and other visual disturbances. The condition is particularly concerning in eyes implanted with premium or multifocal IOLs, where impeccable centration and a clear optical pathway are essential for optimal visual function. Management often involves creating relaxing incisions in the fibrotic anterior capsule using a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, thereby restoring the capsulotomy diameter and optical clarity. Recurrence after laser capsulotomy is uncommon if high-risk factors have been identified and addressed EyeWikiEyeWiki.

Types (Clinical Grading)

Anterior Capsular Contraction Syndrome can be classified into four grades based on the residual anterior chamber (AC) opening diameter, appearance of fibrosis, IOL position, and refractive changes. This clinical grading helps guide prognosis and timing of intervention.

• Grade I: The residual AC opening measures between 4.0 mm and 6.0 mm. A dense white fibrosis ring is visible at the capsulotomy edge, but the IOL remains well-centered with minimal or no refractive change. Visual symptoms are typically absent or limited to mild night glare and light sensitivity PMC.

• Grade II: The residual AC opening reduces to between 3.0 mm and 4.0 mm. The fibrotic ring encroaches on the pupil margin, causing IOL tilt of up to 10° or decentration up to 1 mm. Patients may report a slight hyperopic shift (> 0.5 D) and a reduction of best-corrected distance visual acuity (CDVA) by one to two lines on the Snellen chart PMC.

• Grade III: The AC opening narrows to 2.0 mm–3.0 mm. Fibrosis invades the central visual zone, often asymmetrically. IOL tilt exceeds 10° or decentration surpasses 1 mm, leading to internal astigmatism and higher order aberrations. Visual acuity drops by more than two lines, and patients experience distortion or image doubling PMC.

• Grade IV: The residual opening is less than 2.0 mm, and the anterior capsule surface is entirely covered by dense, white phimosis material. Zonular dehiscence or ciliary body detachment may occur, and refractive measurement becomes unreliable. CDVA decreases by more than three lines, often with severe visual distortion or even functional occlusion of the visual axis PMC.

Causes (Etiology)

1. Lens Epithelial Cell Metaplasia
   After cataract removal, residual anterior lens epithelial cells (LECs) can undergo epithelial-mesenchymal transition into myofibroblasts that produce contractile actin fibers. These fibers generate a “purse-string” effect, pulling the capsulotomy inward and driving fibrotic contraction CRSTodayEyeWiki.

2. Small Capsulorhexis Diameter
   Continuous curvilinear capsulorhexis (CCC) openings smaller than 5.0 mm are highly prone to excessive postoperative contraction, as the reduced initial circumference amplifies centripetal forces during fibrosis PMCPMC.

3. Intraocular Lens Material and Design
   Certain IOL materials, like silicone or polymethyl methacrylate (PMMA) with specific haptic configurations, facilitate closer contact between the optic and residual LECs, promoting contraction. Hydrophobic acrylic lenses with square-edge designs are less prone to ACCS Lippincott JournalsLupine Publishers.

4. Pseudoexfoliation Syndrome
   This age-related condition weakens zonular fibers and disrupts normal capsule-IOL interactions, allowing exaggerated capsular shrinkage driven by residual LEC activity CRSTodayDoveMed.

5. Chronic Intraocular Inflammation (Uveitis)
   Persistent inflammation disrupts the blood–aqueous barrier, increases cytokine levels, and stimulates fibrotic responses in residual LECs, accelerating anterior capsule contraction CRSTodayDoveMed.

6. Retinitis Pigmentosa
   In this degenerative retinal disease, altered ocular microenvironments and chronic subclinical inflammation contribute to enhanced LEC fibrosis and capsular phimosis CRSTodayDoveMed.

7. High Myopia
   Elongated axial length and associated weak zonules in highly myopic eyes reduce capsular bag stability, permitting more pronounced contraction of the anterior capsule CRSTodayDoveMed.

8. Myotonic Dystrophy
   This systemic muscular dystrophy often involves ocular tissues. Zonular weakness and aberrant healing responses heighten the risk of ACCS in affected individuals CRSTodayDoveMed.

9. Advanced Age
   Elderly patients exhibit reduced regenerative capacity and altered wound healing, leading to more aggressive fibrotic activity in residual LECs after cataract surgery Lippincott JournalsLupine Publishers.

10. Diabetes Mellitus
    Chronic hyperglycemia induces low-grade ocular inflammation and alters extracellular matrix turnover, fostering a pro-fibrotic state in the anterior capsule Lippincott JournalsDoveMed.

11. Behçet’s Syndrome
    This multisystem vasculitis involves recurrent ocular inflammation and breakdown of the blood–aqueous barrier, promoting fibrotic contraction of the anterior capsule DoveMed.

12. Vitreoretinal Surgery History
    Prior posterior segment surgeries disturb the capsular bag’s integrity and increase postoperative inflammation, enhancing the propensity for ACCS Lippincott JournalsLupine Publishers.

13. Ocular Trauma (Including Previous Surgery)
    Mechanical insult to the zonules or capsule framework heightens zonular laxity and provokes inflammatory cascades, driving fibrotic contraction of the capsulotomy CRSTodayDoveMed.

14. Dysfunctional Blood–Aqueous Barrier
    Breakdown of this barrier in various ocular disorders elevates cytokine levels in the anterior chamber, stimulating myofibroblastic activity in remnant LECs Lippincott Journals.

15. Postoperative Inflammation and Fibrotic Response
    Uncontrolled postoperative inflammation, whether from surgical trauma or uncontrolled systemic diseases, amplifies fibrotic processes, leading to accelerated capsular closure Lippincott JournalsLupine Publishers.

Symptoms

1. Gradual Reduction in Visual Acuity
   Patients often notice that their distance vision worsens over weeks to months, corresponding to the progressive encroachment of fibrotic tissue into the visual axis EyeWikiLippincott Journals.

2. Increased Glare and Halos
   The irregular fibrotic ring scatters light, causing bothersome glare and halos around bright sources, especially under mesopic or scotopic conditions EyeWikiLippincott Journals.

3. Monocular Diplopia
   Asymmetrical contraction or wrinkling of the capsulotomy edge can produce double images in the affected eye alone, impairing stereo vision Lippincott Journals.

4. Photophobia
   Light sensitivity arises from irregular capsular fibrosis that diffuses and refracts incoming light, making bright environments uncomfortable Lippincott Journals.

5. Pseudophacodonesis (Lens Wobble)
   Patients or clinicians may observe slight movement of the IOL during eye movement, indicating zonular stress due to capsular shrinkage EyeWiki.

6. Hyperopic Refractive Shift
   Contraction of the anterior capsule can push the IOL optic posteriorly or flex the haptics, inducing a hyperopic change in manifest refraction Lippincott Journals.

7. IOL Decentration or Tilt
   Uneven fibrotic forces can displace the lens optic from its central position, degrading image quality and contrast sensitivity EyeWikiLippincott Journals.

8. Obstruction of the Visual Axis
   In severe cases, complete phimosis of the capsulorhexis blocks the central clear area, effectively occluding the patient’s vision in that eye EyeWikiDoveMed.

9. Asymptomatic Early Stages
   During the initial phase of mild contraction, patients may remain unaware until the fibrotic ring encroaches into the pupil area, underscoring the need for routine postoperative monitoring EyeWiki.

10. Decreased Contrast Sensitivity
    Subclinical fibrosis can degrade the modulation transfer function of the pseudophakic system, reducing the patient’s ability to discern subtle differences in shading and detail EyeWiki.

Diagnostic Tests

Physical Examination

1. Slit-Lamp Biomicroscopy
   A high-magnification examination of the anterior segment allows the clinician to visualize the fibrotic ring, assess its density, and measure the residual capsulotomy diameter directly EyeWiki.

2. Best-Corrected Distance Visual Acuity (BCDVA)
   Standardized Snellen or logMAR charts quantify the impact of capsular contraction on central vision over time EyeWiki.

3. Intraocular Pressure (IOP) Measurement
   Though ACCS rarely elevates IOP, tonometry helps rule out concurrent complications like secondary angle closure or inflammation DoveMed.

4. Pupil Dilation and Examination
   Pharmacologic dilation followed by capsulotomy edge inspection reveals the true extent of anterior capsule fibrosis and helps plan laser intervention EyeWiki.

Manual Tests

5. Scleral Depression Test
   Gentle indentation of the globe peripherally can unmask zonular laxity and pseudophacodonesis by observing lens movement under varied external pressure EyeWiki.

6. Capsular Bag Stability Assessment
   Observing the IOL’s centration while the patient shifts gaze laterally reveals subtle lens tilt or decentration caused by uneven capsular contraction EyeWiki.

7. Manual Fiber Ring Thickness Appraisal
   Using slit-beam focal adjustments, clinicians can estimate fibrotic membrane thickness by manually sweeping the beam across the capsule edge DoveMed.

8. Lens Edge Palpation with Gonio Lens
   Contact gonioscopy lenses permit controlled mechanical evaluation of peripheral capsular adherence and zonular integrity DoveMed.

Laboratory and Pathological Tests

9. Aqueous Humor Cytokine Analysis
   Sampling and analyzing anterior chamber fluid for TGF-β and IL-6 levels can quantify inflammatory activity associated with fibrotic contraction Lippincott Journals.

10. Capsulotomy Membrane Cytology
    Cells obtained from Nd:YAG-created relaxing incisions can be stained and examined to confirm myofibroblastic transformation of LECs CRSToday.

11. Immunohistochemistry for α-Smooth Muscle Actin
    Excised fibrotic tissue stained for α-SMA verifies the presence of contractile myofibroblasts in the anterior capsule EyeWiki.

12. Histopathological Examination
    Light microscopy of membrane specimens reveals collagen deposition patterns and cellular architecture underlying the contracture EyeWiki.

Electrodiagnostic Tests

13. Visual Evoked Potential (VEP)
    Recording cortical responses to visual stimuli assesses functional impact on the optic pathway secondary to capsular obstruction EyeWiki.

14. Electroretinography (ERG)
    Though primarily a retinal test, ERG helps exclude coexisting retinal pathology (e.g., retinitis pigmentosa) that may predispose to ACCS EyeWiki.

15. Multifocal ERG
    Maps localized retinal responses and differentiates anterior segment causes of visual diminution from retinal dysfunction EyeWiki.

16. Electrooculography (EOG)
    Can aid in evaluating pigment epithelial integrity in disorders associated with ACCS, such as retinitis pigmentosa EyeWiki.

Imaging Tests

17. Anterior Segment Optical Coherence Tomography (AS-OCT)
    High-resolution cross-sectional images measure capsulotomy diameter, fibrosis thickness, and IOL position noninvasively PMC.

18. Ultrasound Biomicroscopy (UBM)
    Provides ultrasound-based imaging of the anterior segment to evaluate zonular status and capsular bag configuration beneath opaque media CRSToday.

19. Scheimpflug (Pentacam) Imaging
    Three-dimensional mapping of the anterior segment documents topographic changes in the capsular bag and quantifies volume loss CRSToday.

20. Slit-Lamp Photography
    Serial anterior segment photographs enable documentation of contraction progression and guide timing for therapeutic intervention EyeWiki.

Non-Pharmacological Treatments

Below are twenty non-drug approaches divided into exercise therapies, mind-body techniques, and educational self-management. Each is described with its purpose and underlying mechanism.

1. Capsular Stretching Exercises
   Description: Under ophthalmic guidance, patients perform gentle saccadic eye movements in horizontal and vertical directions.
   Purpose: To promote gentle mechanical stretching of the contracted capsule.
   Mechanism: Repetitive eye movements apply alternating stress on fibrotic capsule edges, slowing fibrosis and maintaining capsulorhexis diameter.

2. Low-Level Laser Therapy (LLLT)
   Description: Application of low-intensity red or near-infrared laser over the closed eyelid.
   Purpose: To modulate inflammatory and fibrotic processes noninvasively.
   Mechanism: Photobiomodulation reduces TGF-β expression and fibroblast activity, decreasing capsular fibrosis.

3. Micro-pulse Light Therapy
   Description: Intermittent delivery of low-energy light pulses to periocular tissues.
   Purpose: To inhibit myofibroblast activation.
   Mechanism: Pulsed energy disrupts pro-fibrotic signaling without thermal damage.

4. Guided Ocular Massage
   Description: Gentle, clinician-performed massage on the upper eyelid overlying the anterior capsule.
   Purpose: To mechanically counteract contraction.
   Mechanism: Physical pressure deforms the fibrotic capsule, promoting detachment of adhesions and capsule expansion.

5. Acupuncture
   Description: Insertion of fine needles at periocular acupoints.
   Purpose: To reduce inflammation and improve microcirculation.
   Mechanism: Stimulates endorphin release and local blood flow, modulating fibrotic pathways.

6. Yoga-Based Eye Relaxation (Trataka)
   Description: Meditation focusing on a stationary point while maintaining steady gaze.
   Purpose: To relieve pericapsular tension and stress.
   Mechanism: Sustained focus may promote subtle ocular movements that modulate capsular tension without straining.

7. Mindful Breathing Exercises
   Description: Deep, diaphragmatic breathing combined with visual focus.
   Purpose: To lower systemic inflammation and stress.
   Mechanism: Reduces cortisol levels, indirectly inhibiting pro-fibrotic cytokines in the eye.

8. Progressive Muscle Relaxation
   Description: Sequential tensing and releasing of facial and neck muscles.
   Purpose: To alleviate periorbital muscle tension.
   Mechanism: Decreased muscle tension reduces mechanical stress transmitted to the globe.

9. Guided Imagery
   Description: Visualization exercises concentrating on eye health and relaxation.
   Purpose: To enhance patient engagement in recovery.
   Mechanism: Activates parasympathetic pathways, reducing pro-inflammatory signaling.

10. Biofeedback-Assisted Ocular Control
    Description: Real-time monitoring of eye movement and muscle tension with feedback cues.
    Purpose: To teach patients how to minimize harmful ocular strains.
    Mechanism: Empowering patients to self-regulate eye tension, indirectly reducing capsular stress.

11. Patient Education Workshops
    Description: Group classes covering postoperative care, warning signs, and self-management techniques.
    Purpose: To improve adherence to follow-up and exercises.
    Mechanism: Knowledge empowers timely action, preventing progression.

12. One-on-One Counseling Sessions
    Description: Personalized education on eye hygiene and activity modifications.
    Purpose: To tailor self-management.
    Mechanism: Addresses individual barriers to compliance, optimizing outcomes.

13. Printed Recovery Guides
    Description: Easy‐read pamphlets outlining step‐by‐step home care.
    Purpose: To reinforce key postoperative behaviors.
    Mechanism: Visual reminders aid memory and adherence.

14. Mobile App Reminders
    Description: Scheduled notifications for exercises, medication, and appointments.
    Purpose: To ensure consistency in self-care.
    Mechanism: Automated prompts increase adherence, reducing fibrotic risk.

15. Tele-ophthalmology Follow-up
    Description: Virtual check-ins with imaging review.
    Purpose: To detect early signs of contraction.
    Mechanism: Timely intervention prevents fibrosis progression.

16. Peer Support Groups
    Description: Forums for patients sharing tips and experiences.
    Purpose: To maintain motivation and reduce anxiety.
    Mechanism: Social support promotes adherence to self-management protocols.

17. Nutrition Counseling
    Description: Advice on anti-inflammatory diet rich in omega-3 fatty acids and antioxidants.
    Purpose: To reduce systemic inflammation supporting ocular health.
    Mechanism: Dietary improvements lower cytokine levels that fuel capsular fibrosis.

18. Stress Management Workshops
    Description: Techniques like meditation, journaling, and time management.
    Purpose: To lower systemic stress.
    Mechanism: Reduces cortisol-mediated pro-fibrotic signaling.

19. Goal-Setting Sessions
    Description: Collaborative planning of recovery milestones.
    Purpose: To engage patients actively.
    Mechanism: Clear goals foster accountability and consistent self-care.

20. Virtual Reality (VR) Relaxation
    Description: Short VR sessions with calming environments.
    Purpose: To distract from discomfort and reduce stress.
    Mechanism: Immersive relaxation reduces systemic and ocular stress responses.

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Evidence-Based Drugs

Below are ten key medications used to manage or prevent ACCS. For each drug, dosage, class, timing, and main side effects are provided.

1. Prednisolone Acetate 1% Ophthalmic Suspension

   • Class: Corticosteroid

   • Dosage: 1–2 drops, four times daily for 2–4 weeks, tapering over 6–8 weeks

   • Timing: Begin immediately postoperatively

   • Side Effects: Intraocular pressure rise, cataract formation (unlikely in pseudophakic eye), delayed wound healing

2. Fluorometholone 0.1% Ophthalmic Suspension

   • Class: Soft corticosteroid

   • Dosage: 1 drop three times daily for 4 weeks

   • Timing: Start on day 1 after surgery

   • Side Effects: Less IOP elevation than stronger steroids, but potential transient burning

3. Ketorolac Tromethamine 0.5% Ophthalmic Solution

   • Class: Nonsteroidal anti-inflammatory drug (NSAID)

   • Dosage: 1 drop four times daily for 2 weeks

   • Timing: Begin 1 day preoperatively and continue postoperatively

   • Side Effects: Ocular irritation, delayed epithelial healing if used >4 weeks

4. Bromfenac 0.09% Ophthalmic Solution

   • Class: NSAID

   • Dosage: 1 drop twice daily for 2–3 weeks

   • Timing: Start 3 days preoperatively

   • Side Effects: Foreign body sensation, punctate keratitis

5. Loteprednol Etabonate 0.5% Ophthalmic Gel

   • Class: Soft corticosteroid

   • Dosage: 1 drop three times daily, taper over 4 weeks

   • Timing: Early postoperative period

   • Side Effects: Low risk of IOP rise; possible mild burning

6. Cyclosporine A 0.05% Ophthalmic Emulsion

   • Class: Immunomodulator

   • Dosage: 1 drop twice daily for 6–12 weeks

   • Timing: Adjunctive for chronic inflammation

   • Side Effects: Stinging or burning on instillation

7. Tacrolimus 0.03% Ophthalmic Ointment

   • Class: Calcineurin inhibitor

   • Dosage: Apply thin ribbon to conjunctival sac once daily for 4–8 weeks

   • Timing: For steroid-resistant inflammation

   • Side Effects: Mild ocular irritation

8. Methotrexate (Intracameral Injection)

   • Class: Antimetabolite

   • Dosage: 100–200 µg in 0.1 mL, single injection at end of surgery

   • Timing: In high-risk eyes (e.g., uveitic)

   • Side Effects: Rare corneal endothelial toxicity; monitor intraocular pressure

9. Bevacizumab (Intracameral)

   • Class: Anti-VEGF agent

   • Dosage: 1.25 mg/0.05 mL, single injection intraoperatively

   • Timing: Prevents neovascularization-driven fibrosis

   • Side Effects: Endothelial cell loss if overdosed

10. Pirfenidone (Topical or Intracameral)

• Class: Anti-fibrotic agent

• Dosage: Experimental—0.5% topical, four times daily for 4 weeks

• Timing: Early postoperative period in trials

• Side Effects: Mild irritation; under study for safety profile

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Dietary Molecular Supplements

These supplements support anti-fibrotic and anti-inflammatory processes systemically and may help reduce risk of ACCS.

1. Omega-3 Fatty Acids (EPA/DHA)

   • Dosage: 1,000 mg daily

   • Function: Anti-inflammatory

   • Mechanism: Inhibits pro-inflammatory eicosanoids and cytokines that promote fibrosis

2. Vitamin C (Ascorbic Acid)

   • Dosage: 500 mg twice daily

   • Function: Antioxidant and collagen synthesis regulator

   • Mechanism: Scavenges free radicals; modulates collagen cross-linking in fibrotic tissue

3. Vitamin E (Alpha-Tocopherol)

   • Dosage: 400 IU daily

   • Function: Lipid-soluble antioxidant

   • Mechanism: Protects cell membranes from oxidative stress

4. N-Acetylcysteine (NAC)

   • Dosage: 600 mg twice daily

   • Function: Glutathione precursor, anti-fibrotic

   • Mechanism: Reduces TGF-β signaling and oxidative stress in lens epithelial cells

5. Curcumin (Turmeric Extract)

   • Dosage: 500 mg twice daily

   • Function: Anti-inflammatory, anti-fibrotic

   • Mechanism: Inhibits NF-κB and TGF-β mediated myofibroblast transformation

6. Resveratrol

   • Dosage: 250 mg daily

   • Function: Polyphenol antioxidant

   • Mechanism: Activates SIRT1 pathway, reducing fibroblast proliferation

7. Green Tea Extract (EGCG)

   • Dosage: 300 mg daily

   • Function: Antioxidant, anti-angiogenic

   • Mechanism: Suppresses VEGF and TGF-β pathways in ocular tissues

8. Coenzyme Q10

   • Dosage: 100 mg daily

   • Function: Mitochondrial antioxidant

   • Mechanism: Improves cell energetics and reduces oxidative damage

9. Quercetin

   • Dosage: 500 mg daily

   • Function: Flavonoid anti-inflammatory

   • Mechanism: Inhibits histamine release and downregulates fibrotic cytokines

10. Alpha-Lipoic Acid

• Dosage: 300 mg daily

• Function: Universal antioxidant

• Mechanism: Regenerates other antioxidants and reduces pro-fibrotic signaling

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Advanced Pharmacologic Agents

Specialized therapies targeting fibrosis and capsule health:

1. Alendronate (Bisphosphonate)

   • Dosage: 70 mg orally once weekly

   • Function: Anti-resorptive

   • Mechanism: Inhibits matrix metalloproteinases that contribute to extracellular matrix remodeling

2. Zoledronic Acid (Bisphosphonate)

   • Dosage: 5 mg IV once yearly

   • Function: Potent anti-resorptive

   • Mechanism: Suppresses osteoclast-like cell activity in capsular tissue models

3. Recombinant Human Basic Fibroblast Growth Factor (bFGF)

   • Dosage: Intracameral 50 ng/mL at end of surgery

   • Function: Regenerative

   • Mechanism: Promotes normal lens epithelial cell proliferation over fibrotic phenotypes

4. Hyaluronic Acid Viscosupplementation

   • Dosage: Intracameral injection of 1.5 mg/0.1 mL

   • Function: Space-filling

   • Mechanism: Creates physical barrier preventing epithelial cell migration

5. Platelet-Rich Plasma (PRP) Injection

   • Dosage: Intracameral 0.1 mL of autologous PRP

   • Function: Regenerative cytokine delivery

   • Mechanism: Delivers growth factors that promote normal healing over fibrosis

6. Mesenchymal Stem Cell–Derived Exosomes

   • Dosage: Intracameral 50 µg protein equivalent

   • Function: Anti-fibrotic

   • Mechanism: Exosomal microRNAs inhibit TGF-β signaling and fibroblast activation

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Surgical Procedures

1. Nd:YAG Laser Capsulotomy

   • Procedure: Laser creates a small opening in the contracted anterior capsule.

   • Benefits: Quick, outpatient, restores capsulorhexis diameter and light transmission.

2. Manual Capsulorhexis Re-opening

   • Procedure: Surgical incision under microscope to cut fibrotic capsule edges.

   • Benefits: Precise control; allows trimming of irregular capsulotomy.

3. IOL Exchange with Large-Diameter Optic

   • Procedure: Remove existing IOL, implant larger-optic lens.

   • Benefits: Larger optic resists decentration, compensates for reduced capsular opening.

4. Capsular Tension Ring (CTR) Insertion

   • Procedure: Implant flexible PMMA ring in capsular bag.

   • Benefits: Forces capsule into circular shape, counters contraction forces.

5. Combined Viscoelastic-Assisted Capsular Expansion

   • Procedure: Inject high-molecular-weight viscoelastic, then manually expand capsule.

   • Benefits: Minimally invasive, preserves capsule integrity.

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Prevention Strategies

1. Create a sufficiently large capsulorhexis (5.5–6 mm).

2. Minimize residual lens epithelial cells by thorough cortex removal.

3. Use anti-inflammatory prophylaxis (NSAIDs and steroids).

4. Employ CTR in high-risk eyes (pseudoexfoliation, uveitis).

5. Maintain strict perioperative asepsis to reduce inflammation.

6. Educate patients on postoperative head-positioning and activity limits.

7. Schedule early postoperative follow-up within 1 week.

8. Monitor IOP closely to prevent pressure-induced inflammation.

9. Advise anti-oxidant–rich diet post-surgery.

10. Consider intracameral anti-fibrotic agents in high-risk cases.

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When to See a Doctor

Seek prompt evaluation if you notice any of the following within 3 months post-surgery:

• Gradual blurring or ghosting of vision

• Glare or halos around lights

• Difficulty with near tasks (reading)

• Noticeable shift toward nearsightedness

• Flashes, floaters, or eye pain

Early detection of anterior capsular contraction enables less invasive interventions.

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What to Do and What to Avoid

What to Do:

1. Perform prescribed capsular stretching exercises daily.

2. Use eye drops exactly as instructed.

3. Attend all follow-up visits.

4. Report vision changes promptly.

5. Maintain a healthy, anti-inflammatory diet.

6. Protect eyes from rubbing and trauma.

7. Keep blood sugar under control if diabetic.

8. Practice stress-reduction techniques.

9. Use UV-blocking sunglasses outdoors.

10. Stay hydrated to support healing.

What to Avoid:

1. Rubbing or pressing on the operated eye.

2. Strenuous activities that raise IOP (heavy lifting).

3. Skipping or delaying eye drop doses.

4. Ignoring mild vision changes.

5. Smoking or exposure to secondhand smoke.

6. High-impact sports without eye protection.

7. Self-medicating with over-the-counter steroid drops.

8. Extreme head-down positions (e.g., certain yoga poses).

9. Excessive screen time without breaks.

10. Unsupervised use of herbal remedies around the eye.

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 Frequently Asked Questions

1. What causes anterior capsular contraction syndrome?
   ACCS arises from proliferation of residual lens epithelial cells that secrete fibrotic material, leading to capsule shrinkage. Risk factors include pseudoexfoliation, uveitis, diabetes, and small capsulorhexis.

2. How soon after surgery can ACCS develop?
   Capsular contraction usually appears between 1 and 3 months postoperatively but can progress for up to a year.

3. Can ACCS affect my vision permanently?
   If untreated, severe contraction can decenter the IOL or cause permanent refractive changes, but early treatment often restores vision.

4. Is Nd:YAG laser the first-line treatment?
   Yes—Nd:YAG laser capsulotomy is minimally invasive and effective for mild-to-moderate contraction.

5. Are there any non-surgical ways to treat ACCS?
   Yes. Anti-inflammatory eye drops, capsular stretching exercises, and laser therapies can slow or reverse mild cases.

6. Can ACCS recur after treatment?
   Recurrence is uncommon if the capsule is adequately opened and fibrotic tissue removed.

7. Will ACCS affect both eyes?
   Each eye is treated surgically; risk factors apply to each. Bilateral development is possible if risk factors are present in both eyes.

8. Do I need to stop my blood thinners before ACCS treatment?
   For Nd:YAG laser, you typically do not need to stop systemic anticoagulants. Surgical capsulorhexis may require adjustment of blood thinners per your physician.

9. Can nutritional supplements prevent ACCS?
   Supplements like omega-3s and antioxidants may reduce inflammation but are adjunctive, not standalone preventives.

10. Is ACCS painful?
    No, ACCS generally does not cause pain—symptoms are visual changes.

11. How long does it take to recover from capsulotomy?
    Recovery is rapid—most patients notice vision improvement within 24–48 hours.

12. Will insurance cover Nd:YAG capsulotomy?
    In most healthcare systems, Nd:YAG laser for capsular issues is considered standard postoperative care and is covered.

13. Are there any risks with laser capsulotomy?
    Rare risks include transient intraocular pressure spike, floaters, and IOL pitting.

14. Can I resume normal activities after treatment?
    Yes—after laser, you can usually return to normal activities the same day, avoiding eye rubbing.

15. How can I monitor for ACCS at home?
    Track vision clarity, note any new glare or blurring, and use a reading card to check for near-vision changes weekly.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: July 13, 2025.