Table 2.

Classification of anterior capsular contraction syndrome.

Gradea	Residual AC opening (mm)	Fibrotic tissue appearance	IOL status	Refractive changes	Visual symptoms
I	<4.0	Dense white fibrosis ring at capsulotomy edge	Haptic deformation	None to minimal	None to mild night glare, light sensitivity
II	<3.0	Fibrosis ring visible in pupil margin	IOL tilt <10° or IOL decentration <1.0 mm Zonule stress	SE change >0.5 D/internal astigmatism	Decrease in CDVA <2 lines
III	<2.0	Fibrosis ring in central visual zone (2.0 mm), possibly asymmetric	IOL tilt >10° or IOL decentration >1.0 mm IOL optic deformation	Internal astigmatism, HOAs	Decrease in CDVA >2 lines image distortion
IV	<1.0	IOL surface covered by dense white phimosis material	Loosening of capsular bag or ciliary body detachment	Refraction not measurable	Decrease in CDVA >3 lines

AC, anterior capsule; CDVA, corrected distance visual acuity; HOAs, higher order aberrations; IOL, intraocular lens; SE, spherical equivalent.

^aFrom this table, 3 of 5 columns must be fulfilled to be graded I to IV.