Anterior Capsular Contraction Syndrome in Cataract Surgery: A Review of Challenges and Solutions

Abstract

In the era of refractive surgery, the primary goal of cataract surgery has evolved from merely restoring vision to ensuring optimal visual outcomes. Advances in surgical precision, standardization, intraocular lens manufacturing, accurate intraocular lens power selection, and postoperative visual quality measures have significantly enhanced visual acuity after cataract surgery. Capsule contraction syndrome (CCS) is characterized by capsular wrinkling and fibrosis, resulting in a decreased equatorial diameter of the capsular bag, decentration, and tilt of the intraocular lens. While CCS is an uncommon complication, its potential effect on vision requires attention from clinicians. This syndrome is caused by the proliferation and fibrosis of lens epithelial cells, leading to shrinkage of the capsule and contraction of the capsulorhexis opening, with the anterior lens capsule becoming thicker and cloudier, impacting visual outcomes and patient satisfaction. With continued research and advancements, the goal is to minimize the occurrence of CCS and optimize visual results for patients undergoing cataract surgery. In this study, we delve into the forefront of CCS research, analyzing its clinical manifestations, etiological factors, influential determinants, mechanistic pathways, preventative strategies, and therapeutic interventions. By understanding CCS and identifying its contributing factors, we can enhance our ability to effectively predict and manage this complication.

Definition and Clinical Features

Cataract surgery is a safe and routine procedure that can significantly improve eyesight. However, complications can arise, one of which is capsule contraction syndrome (CCS). Identified by Davison in 1993, CCS occurs when the capsular bag at the equator shrinks following cataract phacoemulsification, leading to opacification, sclerosis, and inward folding of the capsule, which reduces the area of the capsular opening (Figure 1) [1,2]. The incidence of CCS ranges from 1.4% to 14%, and it typically occurs within 3 to 30 weeks after surgery, with capsular wrinkling decreasing after 3 months after surgery [3].

Figure 1.

The sequential mechanisms contributing to capsule contraction syndrome (CCS) following cataract surgery. The process begins with surgical trauma to the anterior capsule, which triggers a proliferative response in residual lens epithelial cells. These cells migrate and secrete pro-fibrotic cytokines, such as TGF-β, leading to excessive extracellular matrix production. The accumulation of collagen and other fibers results in the thickening and wrinkling of the capsular bag, ultimately compromising visual acuity. The arrows indicate the flow of events from surgical intervention to the development of CCS, highlighting critical points where intervention can be necessary to mitigate this complication. Figure created with BioRender.com.

The primary clinical manifestations of CCS include opacification and folding of the capsule, which reduce the amount of light entering the eye and affect the clarity of the retinal image [4,5]. CCS can result in adverse events such as intraocular lens (IOL) tilting, decentration, rotation, or dislocation, all of which can significantly affect visual quality. In cases of posterior displacement, the IOL can descend into the vitreous cavity, potentially leading to severe complications, such as cystoid macular edema, choroidal detachment, and retinal detachment [2]. Moreover, the distortion of the capsular bag can exert pressure on the IOL, causing it to shift and resulting in secondary refractive errors, leading to varying degrees of myopia or hyperopia [6,7]. In a study, it was reported that 42% of patients with CCS experienced a myopic shift to different extents [8–10]. Another study revealed that, among 5 patients with capsular bag shrinkage, varying degrees of myopia were observed in all, while 3 patients showed signs of hyperopia [11]. Despite the established understanding of CCS and its associated complications, significant gaps remain in the literature regarding its underlying mechanisms, optimal management strategies, and long-term outcomes for affected patients [12]. Current studies primarily focus on the incidence and immediate effects of CCS, yet there is limited exploration of the risk factors contributing to its development or the best practices for prevention and intervention. Furthermore, the variability in patient responses to CCS and to its effect on visual acuity over time remain inadequately addressed [9]. In this study, we aimed to fill these gaps by providing a comprehensive analysis of CCS, enhancing our understanding of its implications for cataract surgery outcomes.

Causes and Influential Factors

Anterior Capsular Opening Diameter

An appropriately sized continuous curvilinear capsulorhexis is essential for maintaining the opening area of the anterior capsule during postoperative capsular fibrosis. This ensures stable positioning of the IOL within the capsular bag and helps prevent complications, such as posterior capsule opacification (PCO) and CCS [13]. Research indicates that a too-small diameter of the capsular opening can lead to postoperative capsular bag wrinkling, increasing the likelihood of CCS [14]. Joo et al suggest that, to prevent capsular bag wrinkling, the ideal diameter of the capsular opening should be between 5.5 mm and 6 mm, or larger [15].

Effects of Lens Epithelial Cells

During cataract surgery, some lens epithelial cells (LECs) are inevitably left behind after cortex removal. These residual cells can adhere to the capsule, where they have the potential to multiply, differentiate into various cell types, and migrate across the capsule surface [16]. This migration allows them to continue multiplying and eventually start synthesizing collagen fibers. These fibers then exert forces on the capsule, leading to its thickening, opacification, sclerosis, and wrinkling [17]. In a study by Lin that focused on post-surgery anterior capsular opacification, a significant finding was that 76% of patients who developed anterior capsular opacification had not undergone capsule polishing during their surgeries. This observation suggests a link between the lack of capsule polishing and the occurrence of anterior capsular opacification [18]. Furthermore, a specific case highlighted the wrinkling of the capsular bag around IOLs made of hydrophilic acrylate. Following the implantation of the IOLs, fibrous tissue proliferation and stiffening occurred around a tear in the capsule. Notably, this case did not involve any known systemic or ocular risk factors [19,20].

The analysis suggests that a significant contributing factor to severe CCS is the lack of capsular polishing. A study by Huang et al focusing on the impact of anterior capsule polishing during surgery revealed that performing a 360° anterior capsule polishing procedure slowed down the development of capsular bag deformation without increasing the risk of anterior capsular opacification or PCO [21]. After 12 months, the group that underwent polishing displayed a notably larger anterior capsular opening area than did the control group. This highlights the critical role of intraoperative polishing procedures in reducing the attachment of LECs to the capsular membrane. By polishing the anterior capsule, cell proliferation can be minimized, and the area of the anterior capsular opening can be maintained, which is crucial for preventing and delaying the progression of CCS [21]. Some studies collectively suggest that while anterior capsule polishing may not directly affect PCO rates, it can have beneficial effects on other complications related to the anterior capsule. Baile et al have showed, in a 3-year study of 1009 eyes undergoing cataract surgery, that there was no significant difference in the rate of PCO between patients who received anterior capsule polishing and those who did not. However, the study showed that anterior capsule opacification and capsular phimosis were significantly reduced in the polishing group, indicating some benefits of the procedure despite its lack of effect on PCO formation [22]. In another study, Koch et al showed that there were no significant differences in PCO rates between hydrophobic and hydrophilic acrylic square-edged IOLs in children aged 5 to 12 years. Both groups experienced significant increases in PCO after 1 year, but comparisons at 3, 6, and 12 months revealed no statistically significant differences [23]. Various studies have reported mixed results regarding the effect of anterior capsule polishing on PCO. Some have suggested that while polishing may not significantly reduce PCO rates, it can lead to a decrease in anterior capsule opacification and capsular phimosis [24,25].

Optical Materials

The optical material and design of IOLs are closely linked to the occurrence of postoperative capsular bag wrinkling (Figure 1). IOL materials can be broadly classified as hard or soft, with polymethyl methacrylate (PMMA) representing the hard category, and soft materials including silicone gel, hydrogel, and acrylate polymers. Research indicates that PMMA IOLs exhibit a higher incidence of PCO than do other materials [26,27]. Werner et al demonstrated that postoperative opacification of the anterior capsule membrane was least frequent with acrylic IOL implantation, when compared with other materials [28].

The percentage of anterior capsule opening area is significantly greater in acrylic IOLs than in silicone gel IOLs [29,30]. Acrylic IOLs are further divided into hydrophilic and hydrophobic types based on surface polarity.

Hydrophilic IOLs are associated with a higher incidence of CCS than are hydrophobic IOLs [31]. This discrepancy is attributed to the ability of hydrophobic IOLs to reduce LEC proliferation and migration [19,32–34]. Notably, hydrophobic acrylic lenses exhibit stronger collagen adhesion, enabling tight attachment to the collagen-rich posterior capsule. This property inhibits LEC proliferation on the IOL surface and reduces capsular opacification rates [35–37]. Conversely, the weaker adhesion of hydrophilic acrylic lenses to the posterior capsule can create an environment conducive for residual LEC proliferation and migration, consequently elevating the risk of capsular opacification. These distinctions emphasize the critical role of IOL material properties in influencing postoperative complications and outcomes in cataract surgery [38,39]. This analysis underscores the importance of selecting appropriate IOL materials and designs to minimize postoperative complications and improve patient outcomes.

IOL Design

The emphasis on postoperative visual quality has driven significant interest in IOL designs to address issues such as capsular opacification and bag shrinkage [40]. Innovations in IOL design have particularly focused on the configuration of the optical component and haptics [41]. IOLs are commonly classified based on their chemical composition, including materials such as silicone gel, hydrogel, PMMA, and acrylate acid. Numerous studies have demonstrated that the incidence of anterior CCS is significantly higher following the implantation of silicone or hydrogel IOLs compared to PMMA or acrylic IOLs [29]. Currently, acrylic IOLs are the predominant choice in clinical practice, while PMMA IOLs are increasingly considered obsolete. Furthermore, IOLs can be categorized as hydrophilic or hydrophobic [42]. A meta-analysis by Chen et al [43] showed that hydrophilic IOLs had higher anterior CCS rates than did hydrophobic IOLs at 1 month, 3 months, 6 months, and 1 year postoperatively. This can be due to the better biocompatibility of hydrophobic IOLs, which enhances their attachment to the capsule and limits lens epithelial cell proliferation and extracellular matrix synthesis, thereby reducing fibrosis and contraction of the anterior capsule [44]. IOLs can be structurally categorized into 1-piece and 3-piece varieties, with further classifications based on the number and shape of haptics-such as double-haptic, triple-haptic, quadruple-haptic, “C”-shaped, “L”-shaped, flat-haptic, and ring-haptic designs [45,46]. The existing literature highlights a connection between the number of haptics and the incidence of postoperative CCS [7]. Recent studies have demonstrated a correlation between the number of IOL haptics and the anterior capsule opening area [47]. The design of IOL edges is crucial in postoperative outcomes. Square edges, despite being less sharp in hydrophilic acrylic variants, are associated with decreased capsular opacification, emphasizing the importance of material properties in postoperative complications [48,49]. These findings underscore the necessity of considering IOL material, design, and fit with respect to the capsulorhexis, to mitigate LEC migration and proliferation toward the optic axis. The presence of square edges not only inhibits the proliferation and migration of residual cells but also serves as a physical barrier, potentially reducing postoperative adverse reactions. Optimizing these factors can significantly enhance postoperative visual outcomes and patient satisfaction (Figure 2) [50–54].

Figure 2.

The classification of intraocular lenses (IOLs) used in cataract surgery. Figure created with BioRender.com.

Cytokine Changes in Aqueous Humor

The aqueous humor, a transparent fluid that fills the anterior and posterior chambers of the eye, serves crucial functions, such as providing nutrients to the cornea and lens and maintaining intraocular pressure [55]. Given the colorless and transparent nature of the lens, which is devoid of blood vessels, its nutrition and metabolism rely entirely on the circulation of the aqueous humor [56,57]. Consequently, the properties and composition of the aqueous humor directly impact cell metabolism, particularly affecting LECs.

In recent years, research has unveiled various factors within the aqueous humor that play pivotal roles in the onset and progression of cataracts, as well as in the proliferation and differentiation of LECs. During surgical procedures, the trauma inflicted triggers a response in LECs, leading to the production of pro-fibrotic or pro-inflammatory cytokines, such as fibroblast growth factor, transforming growth factor (TGF)-β, interleukin-1, and interleukin-6. These cytokines alter the microenvironment of the aqueous humor, stimulating the secretion of collagen and fibers [58]. The accumulation of these new fibers exerts tension on the capsular bag, resulting in wrinkling and eventual fibrosis, along with deformation of the capsule. This cascade of events underscores the intricate interplay between surgical trauma, cytokine release, changes in the aqueous humor microenvironment, and structural alterations in the lens capsule [58]. Understanding these processes is crucial for mitigating complications, such as capsular bag wrinkling and fibrosis after surgery, thereby enhancing overall surgical outcomes and patient well-being.

Elasticity of the Zonular Fibers

Capsular wrinkling is closely associated with the elasticity of the lens’s zonular fibers. In patients with partial damage, congenital uneven development, or laxity of the zonules, such as those with uveitis, a history of intraocular surgery, high myopia, retinitis pigmentosa, Marfan syndrome, or myotonic dystrophy, uneven forces on the zonular apparatus can easily lead to capsulorhexis deformation, due to mechanized pulling [59]. Even with intraoperative implantation of the IOL into the capsular bag, postoperative capsular wrinkling and lens dislocation are more likely because the zonules are fragile and cannot resist the centripetal force from capsular wrinkling. Mechanized anterior capsular opacification has been documented in cases of advanced retinitis pigmentosa and cone-rod cell dystrophy [60,61]. In addition, pseudoexfoliation syndrome leads to wrinkled mechanization of the anterior capsule membrane in patients [62]. Xu et al found that patients without risk factors for CCS had significantly later postoperative onset of CCS and less anterior capsule wrinkling than did those with comorbid risk factors, such as diabetes mellitus, uveitis, and glaucoma [9].

CCS Pathogenesis

The exact mechanisms underlying CCS remain poorly understood. Factors such as surgical trauma during cataract surgery, postoperative inflammation related to IOL implantation, and disruptions to ocular barriers contribute to CCS pathogenesis [9]. These factors stimulate residual LECs near the capsulorhexis, triggering excessive extracellular matrix production, particularly collagen fibers [63,64]. Consequently, LECs can transform into myofibroblasts, intensifying matrix synthesis and inducing capsule contraction [65]. Histopathological studies showed that anterior capsule membrane turbidity mechanization is associated with myofibroblast chemotaxis in LECs [66].

Additionally, LECs can undergo epithelial-mesenchymal transition (EMT), transforming into myofibroblasts expressing α-smooth muscle actin and secreting excessive extracellular matrix, leading to capsule membrane stretching and light scattering (Figure 2) [67,68]. The resulting manifestations, such as wrinkled capsule membranes, matrix deposition, and characteristic formations, severely impair vision quality, causing secondary vision loss [69]. Numerous signaling pathways and factors actively participate in the process of EMT, a pivotal mechanism in various pathological conditions. Among these, the TGF-β/Smad pathway stands out as a crucial player [70,71]. Extensive research demonstrates the profound impact of the pro-fibrotic cytokine TGF-β in the genesis of posterior capsule opacification. Often hailed as a master regulator of fibrosis, TGF-β assumes a central role in the onset of EMT and posterior capsule opacification [72]. Typically dormant in its latent form within the body, TGF-β undergoes activation after cataract surgery, breaching the blood-aqueous barrier. This surge in TGF-β activity triggers capsular fibrosis, culminating in the wrinkling of the capsular bag [64,73,74]. Notably, the Smad7 protein emerges as a potential EMT inhibitor, offering a promising avenue to significantly diminish the incidence of PCO [75].

In the realm of cataract pathology, osteopontin assumes a critical role by facilitating the adhesion, migration, and chemotaxis [76]. Studies underscore the involvement of osteopontin in the development of vesicle opacities, influencing the proliferation and differentiation of LECs [77]. Additionally, the levels of platelet-derived growth factor-A in the aqueous humor exhibit a positive correlation with postoperative PCO severity, implicating platelet-derived growth factor-A in the progression of PCO [78,79]. Additionally, Ruihua et al investigated the impact of granulocyte colony-stimulating factor (G-CSF) on human lens epithelial cells (HLEC-B3), revealing its ability to promote cell proliferation in vitro. G-CSF exerts a promotional influence on cell proliferation, migration, EMT, and extracellular matrix synthesis in HLEC-B3 cells, potentially implicating it in the development of PCO. Further investigation is warranted to elucidate the precise mechanisms underlying its involvement in PCO development, fibrosis, cell migration, and proliferation [80].

Matrix metalloproteinase 2, a pivotal extracellular matrix modulator, plays a significant role in TGF-β2-mediated matrix contraction and posterior capsule opacification. Inhibiting matrix metalloproteinase 2 presents a novel therapeutic strategy for addressing CCS, PCO, and potentially other fibrotic disorders [81]. Such inhibition can be achieved via 2 primary methods: direct administration of matrix metalloproteinase inhibitors during surgery through a closed delivery system, minimizing the effect on intraocular tissues [82], or by incorporating the inhibitor into the IOL and capsular bag during surgery [83–85].

Preventative Strategies

Surgical Techniques

During the tearing process, meticulous attention must be paid to the surgical technique. The diameter of the capsular opening should not be less than 5.5 mm to 6 mm, to prevent capsular bag wrinkling. Additionally, polishing the capsule membrane can minimize the attachment of LECs [86]. For eyes with unhealthy lens suspensory ligaments, using a capsular bag tension ring can be beneficial, along with gentle manipulation, to avoid damaging the suspensory ligaments [87,88]. As previously noted, LECs left on the capsulorhexis can proliferate postoperatively and migrate, causing mechanical deformations that result in eccentric tilting of the lens or even subluxation. Intraoperative polishing of the capsulorhexis effectively reduces LEC adhesion, which is crucial for minimizing the incidence of postoperative capsulorhexis wrinkling and enhancing the stability and centering of the IOL [89].

IOL Selection

Selecting IOL materials that are less likely to induce CCS is essential; hydrophobic acrylic is preferable to hydrophilic acrylic. The distribution and quantity of haptics on the IOL should be uniform and ample, positively influencing the stability of the IOL and reducing the likelihood of CCS following surgery [90]. A 360° straight corner design is advantageous for decreasing the incidence of postoperative capsular opacification. Recent advancements have led to the development of various IOLs designed to prevent or resist capsular opacification [91]. These include anti-biofouling IOLs that effectively resist cell adhesion and cohesion-enhancing IOLs that promote tight adherence between the posterior capsule and the IOL. Additionally, there are micro-patterned surface IOLs, IOLs using photodynamic inhibition of LEC growth, and drug-loaded IOLs [92].

Drug Prevention

In addition to improving surgical methods and selecting appropriate IOL materials and designs, postoperative medication and identifying key targets for drugs that can prevent capsular puckering are currently significant research areas in CCS management [91]. First, the application of postoperative anti-inflammatory drops is critical for reducing inflammatory responses, thereby minimizing irritation to LECs and preventing the onset of capsular wrinkling. Second, certain drugs can help prevent CCS by inhibiting the proliferative growth of LECs. Hybiak et al [93] demonstrated that aspirin can inhibit the EMT process of LECs, with this effect being evident in a human lens capsular bag model. This inhibitory effect increases with higher concentrations of aspirin, indicating its potential for preventing and treating complications arising from LEC migration and proliferation. This suggests that IOL-loaded drugs can become an important and viable strategy for preventing postoperative capsular opacification. The relationship between G-CSF and PCO reveals that G-CSF promotes LEC migration, the EMT process, and extracellular matrix synthesis [94]. Targeting G-CSF expression could be a promising approach for local PCO treatment and may help control its development [94,95]. Further research is warranted to explore the effect of G-CSF on the incidence of CCS. Additionally, Smith et al [71] found that treatment with resveratrol significantly suppressed gene expression associated with fibrotic diseases induced by TGFβ-2, inhibited the growth of LECs on the posterior capsule, and notably reduced capsule wrinkling. Thus, resveratrol is a viable candidate for preventing capsular opacification, which could benefit millions of cataract patients.

Therapeutic Interventions

CCS can be managed using various treatment options, categorized into invasive surgical procedures and noninvasive laser techniques. The most commonly used treatments include capsular bag relaxing surgery (CBRS) and neodymium-doped yttrium aluminum garnet (Nd: YAG) laser surgery [43].

Invasive Surgical Treatment Options

CBRS is an invasive approach that entails re-circular capsulorhexis (re-continuous curvilinear capsulorhexis) and radial incision release [6]. Xu et al [96] performed CBRS on 25 patients with CCS following cataract surgery and reported a significant improvement in postoperative visual acuity, compared with preoperative levels. CBRS is particularly effective in cases of severe fibrosis, which leads to thickening of the capsule and substantial bag shrinkage that displaces the IOL. The procedure involves using capsular membrane scissors to cut the capsular membrane, followed by a tearing operation with forceps [97]. One of the main advantages of CBRS is its ability to ensure the centrality and stability of the IOL after surgery, along with creating a smoother capsulorhexis edge. However, challenges arise if the proliferation of fibrous tissue causes the capsulorhexis to become unevenly thickened [98]. This can result in skewed tearing during the operation, potentially compromising the stability of the crystalline complex and causing uneven stress on the suspensory ligament, or even rupturing the capsulorhexis afterward. Wilde et al [99] noted the risks associated with this procedure, including potential interference with vision and damage to the corneal endothelium due to free-floating residues from the circular capsule incision. They preferred the radial incision release method, which involves first releasing the adhesion of the anterior capsule membrane to the IOL, followed by making a radial incision along the edge of the anterior capsule opening. This is done using capsule scissors in a direction perpendicular to the equator, with the incision length determined by the thickness of fibrous proliferation and the degree of capsule puckering and IOL deviation [100]. Although CBRS remains relevant, its inherent invasiveness, complex surgical design, and potential postoperative complications have limited its adoption as a mainstream procedure [101,102].

Table 1 shows the recent advances in therapeutic interventions for capsule contraction syndrome.

Table 1.

Recent advances in therapeutic interventions for capsule contraction syndrome.

Treatment option	Key findings	Reference
Invasive surgical treatment options	Significant improvement in postoperative visual acuity after capsular bag relaxing surgery; effective in severe fibrosis cases	[96]
	Risks including potential vision interference and corneal endothelium damage; radial incision method preferred	[99]
Noninvasive laser treatment	Modified C-type neodymium-doped yttrium aluminum garnet (YAG) laser capsulotomy technique for fibrous tissue proliferation; lower postoperative complications	[100]
	Ring YAG laser was more effective in capsular bag contraction relief than radial YAG laser; safer approach	[109]
	Femtosecond laser-assisted capsulotomy for capsular bag crumpling; stability in crystalline position was observed	[110]

Non-invasive Laser Treatment

YAG laser surgery is currently the preferred method for treating CCS, due to its safety, effectiveness, and simplicity. However, it is not suitable for all patients, particularly those with nystagmus or who are non-cooperative [103]. In cases in which there is significant fibrous proliferation on the capsule, extensive IOL excursion, and severe capsule wrinkling, multiple treatments or higher energy levels can be required, which can intensify the intraocular inflammatory response [104]. Additionally, the risk of laser-induced damage to the iris, IOL, posterior capsule, and anterior vitreous border membrane is greater than that with CBRS. A 2020 study reported a modified C-type YAG laser capsulotomy technique that involves creating a ring-shaped cut in the anterior capsule above the fibrotic tissue proliferation area [100]. This allows the capsule to naturally settle at the inferior equator, alleviating visual axis obstruction caused by fibrous proliferation and improving vision. The C-type YAG laser is a modified version of the traditional YAG laser, specifically designed for enhanced precision and control during procedures. This laser uses a unique optical configuration that allows for a more focused beam, which can be precisely directed at the fibrotic tissue without affecting the surrounding structures [105]. One of the key advantages of the C-type YAG laser is its ability to deliver energy in a controlled manner, which reduces the overall energy required for effective treatment. This feature not only minimizes the risk of thermal damage to adjacent tissues but also lowers the likelihood of postoperative complications, such as inflammation or damage to the iris and IOL [106]. Studies have shown that the C-type YAG laser technique results in a significantly higher rate of capsular bag contraction relief than do traditional radial YAG laser methods, making it a safer and more effective option for patients with CCS [107,108]. Elmohamady et al conducted follow-up studies comparing patients treated with ring YAG laser and radial YAG laser techniques, finding that the rate of capsular bag contraction relief was significantly higher in the ring group (94.4%) than in the radial group (66.7%). Importantly, there was no significant difference in intraocular pressure between the 2 groups [109]. These findings indicate that the ring YAG laser method is safer and more effective than the radial YAG laser approach. Femtosecond laser-assisted capsulotomy represents the latest advancement in therapeutic procedures. Recalde et al reported a case in which this technique was performed in a patient who developed capsular bag wrinkling after monocular cataract surgery. After 29 months of follow-up, they observed stability in the crystalline position and no damage to the IOL [70,110]. The introduction of laser treatments, particularly the YAG laser method, has significantly addressed the issue of visual acuity decline due to postoperative capsule opacification. However, some patients have experienced complications, such as IOL tilting or displacement, macular edema, retinal detachment, retinal tears, uveitis, and increased intraocular pressure following laser treatment [111]. In severe cases, the improvement in anterior capsule wrinkling after laser treatment can be insufficient. Therefore, preventing the occurrence of CCS is of paramount importance.

Conclusions

CCS is a rare but significant complication of cataract surgery that can lead to impaired visual outcomes. Effective prevention involves precise continuous curvilinear capsulorhexis, thorough polishing of the capsule, and proper centration of the IOL. Early detection through routine follow-up is critical for timely intervention. While current treatments primarily involve surgical or laser approaches, there is a clear need for further research into pharmacological strategies that can inhibit lens epithelial cell proliferation. Improving patient education and postoperative monitoring can also play a vital role in reducing CCS incidence and enhancing surgical outcomes.

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