BACKGROUND: Capsule contraction syndrome (CCS) after cataract surgery causes intraocular lens (IOL) haptic flexion and IOL optic displacement in most former reports. However, there are few reports on CCS-induced deformation of the IOL optic. We report two cases of CCS after cataract surgery in highly myopic eyes and describe a previously unreported \"double arch\" complication.
METHODS: Two patients with history of high myopia had cataract surgery with hydrophilic acrylic plate haptic IOLs implanted in their eyes. CCS with arch shape deformation of the pupil as well as the optic of the IOL were noticed in both cases after three months, which induced refractive changes and corrected distance visual acuity (CDVA) deterioration. Visual acuity of the patients was restored by replacing the IOL from the capsular bag to the ciliary sulcus and the following neodymium: YAG (Nd:YAG) laser capsulotomy. We propose that such \"double arch\" change brought by CCS is related to the plate-haptic design of the IOL and the incomplete overlap between the capsular opening and the IOL optic.
CONCLUSIONS: We recommend careful IOL selection and proper capsulorhexis in patients with high myopia or with other risk factors of CCS. Early diagnosis and timely treatment of CCS are critical to prevent visual symptoms and further ocular complications.

BACKGROUND: Increasing interest in microincision cataract surgery has led to the use of more flexible intraocular lens (IOL). Flexible IOL may cause more IOL deformation and refractive error when capsule contraction syndrome (CCS) occurred. In this retrospective observational case series study, the aim was to report four cases of hyperopic shift caused by CCS after phacoemulsification with microincision foldable intraocular lens implantation.
METHODS: All of four patients underwent phacoemulsification and in-the-bag implantation of an Akreos MI60 (Bausch and Lomb) IOL from 2010 to 2016 in our clinic. These patients had been diagnosed with CCS and had undergone Nd:YAG laser anterior capsulotomy. The mean age of the patients with CCS was 66.8 ± 6.7 years and the mean time for development of CCS after the cataract surgery was 9.3 ± 6.9 months. The mean spherical equivalent (SE) value at the time of the CCS diagnosis was 0.88 ± 0.91 D, which had shown a hyperopic shift compared to the SE value of - 0.91 ± 1.29 D after cataract surgery. The mean SE decreased by - 0.47 ± 1.14 D after Nd:YAG laser anterior capsulotomy. The mean age, axial length, anterior chamber depth, and preoperative SE were not significantly different between the patient with CCS and the patients without CCS.
CONCLUSIONS: In the case of IOL implantation with flexible materials in microincision cataract surgery, CCS can cause a hyperopic shift. Refractive error caused by CCS can be effectively corrected by Nd:YAG laser anterior capsulotomy.

In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.

Here we present 2 cases of capsule contraction syndrome (CCS). In both cases, a hydrophilic acrylic Akreos MI60 (Bausch and Lomb) intraocular lens (IOL) was implanted in the capsular bag through microincision cataract surgery, and the literature on the subject is reviewed. Since CCS has been described after the implantation of every IOL type, it is unlikely that the Akreos MI60 chemical and physical properties may cause CCS. When CCS occurs with IOLs composed of increasingly flexible materials that are inserted through incisions of decreasing size, a severe dislocation and deformation of IOL optics and haptics may develop. In both cases illustrated here, Nd:YAG laser anterior capsulotomy was highly effective. Hence, also based on the literature, which reports severe complications as a result of surgical intervention, it is suggested that Nd:YAG laser anterior capsulotomy be the first line of CCS treatment when the luxation of an IOL capsular bag is absent.

We reported the case of a 39-year-old patient with inactive Behcet\'s syndrome developed capsule contraction syndrome after uneventful phacoemulsification and a foldable intraocular lens implantation. Two weeks after the operation, the patient was accepted to hospital with severe decrease of visual acuity (VA) on the operated eye. Capsule opening area had been reduced considerably by fibrotic tissue, which evaluated with full dilated pupil. Since capsule contraction syndrome (CCS) had been diagnosed in very early stage and which structure was not severely thick, the fibrotic band was treated successfully, 360 degree circular shape, by neodymium YAG (Nd:YAG) laser. Capsule opening area was remained stable during follow up period of one month. But a significant reocclusion was developed that need surgical reopening 3 months after initial operation. Continuous curvilinier capsulorhexis (CCC) may be recurred again after a successful treatment in patient with uveitis like Behcet\'s disease.