Imagem novembro 26, 2025 novembro 26, 2025

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

DOI: 10.37039/1982.8551.20250092

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 (). 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 (). 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.⁽⁾

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