Capsulorhexis phimosis in retinitis pigmentosa despite capsular tension ring implantation

A 56-year-old man with retinitis pigmentosa presented with dense nuclear sc lerosis and scattered zonular loss with laxity confirmed by ultrasound biom icroscopy. He had extracapsular cataract extraction with a 6.0 mm continuou s curvilinear capsulorhexis and implantation of a capsular tension ring (CT R) and a single-piece poly(methyl methacrylate) (PMMA) intraocular lens (IO L in the capsular bag in his left eye. Severe anterior capsule fibrosis and contracture of the capsulorhexis opening with nasal decentration of the IO L were noted 4 months after surgery. A neodymium:YAG (Nd:YAG) laser anterio r capsulotomy was performed to prevent further zonular stress and IOL decen tration. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR and PMMA IOL in patients with retinitis pigmentosa. Such patients must be carefully monitor ed postoperatively. An Nd:YAG laser anterior capsulotomy is a safe and effe ctive option to manage anterior capsule fibrosis. (C) 2001 ASCRS and ESCRS.