Capsular bag folding associated with in-the-bag intraocular lens displacement in pseudoexfoliation syndrome

Dobra da bolsa capsular associada ao deslocamento da lente intraocular in-the-bag na síndrome de pseudoexfoliação

Keywords:
Exfoliation syndrome; Lenses,; intraocular; Eye, artificial

Descritores:
Síndrome de exfoliação; Lentes intraoculares; Olho artificial

Keywords:
Exfoliation syndrome; Lenses,; intraocular; Eye, artificial

Descritores:
Síndrome de exfoliação; Lentes intraoculares; Olho artificial

We present the case of an 80-year-old patient diagnosed with severe pseudoexfoliation syndrome (PEX) in both eyes (OU), who underwent uneventful bilateral phacoemulsification with in-the-bag intraocular lens (IOL) implantation 10 years ago. However, 4 years postoperatively, the patient developed subluxation of the capsular bag-IOL complex in the left eye, attributable to the progressive zonular insufficiency characteristic of PEX. Consequently, the subluxated IOL was removed, and an iris-fixated lens was implanted.

During follow-up, 6 years after the initial surgery, a similar phenomenon was observed in the right eye. Anterior segment biomicroscopy (ASB) revealed capsular bag folding associated with in-the-bag IOL subluxation (Figure 1). The anterior segment optical coherence tomography (AS-OCT) confirmed zonular instability, evidenced by collapse and folding of the posterior capsule, manifesting as an irregular retraction causing displacement of the IOL (Figure 2). This finding is typical of advanced PEX, in which progressive zonular insufficiency compromises the integrity of the capsule-IOL complex, potentially leading to late decentration or dislocation.(¹)

Figure 1
Anterior segment biomicroscopy revealed a translucent deposit centered in the retropupillary area, corresponding to a capsular bag fold with intrasaccular fluid accumulation.

Figure 2
Anterior segment optical coherence tomography showed a perfectly circumferential fold of the capsular bag, with inferior displacement of the lens.

This case underscores the importance of prolonged monitoring in patients with PEX who have undergone cataract surgery, given the progressive nature of zonular deterioration and the inherent risk of late subluxation of the capsular bag-IOL complex.

• Institution:
  Ophthalmology Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain.
• Financial support:
  no financial support for this work.

REFERENCES

• ¹ Vazquez-Ferreiro P, Carrera-Hueso FJ, Fikri-Benbrahim N, Barreiro-Rodriguez L, Diaz-Rey M, Ramón Barrios MA. Intraocular lens dislocation in pseudoexfoliation: a systematic review and meta-analysis. Acta Ophthalmol. 2017;95(3):e164-9.

Edited by

• Associate Editor:
  Ricardo Augusto Paletta Guedes Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil https://orcid.org/0000-0002-9451-738X

Publication Dates

• Publication in this collection
  15 Dec 2025
• Date of issue
  2025

History

• Received
  04 Aug 2025
• Accepted
  11 Sept 2025