Ciliary Body Detachment Caused by Capsule Contraction
In their recent paper, Lanzl and Kopp1 reported hypotony and ciliary body detachment induced by capsular bag contraction as a complication of phacoemulsification with intraocular lens (IOL) implantation. It is believed that pseudophakia is a contributing factor, as the IOL material, shape, and haptic design play roles.
However, the IOL is not essential for the appearance of this phenomenon. Capsular bag contraction can cause ciliary body detachment and hypotony in aphakic eyes as well. In 1983, we reported hypotony (intraocular pressure [IOP] 0 mm Hg) and detachment of the ciliary body and choroid that appeared 5 months after uneventful phacoemulsification without IOL implantation and was resolved by posterior capsulotomy. At the time this case appeared, ocular anterior segment imaging was not available and we based our diagnosis on the clinical observation only. Examination of the eye with hypotony revealed anteriorly displaced ciliary processes bulging through the surgical iris coloboma. The ciliary processes were connected to the posterior capsule with traction lines directed toward the center of the capsule. Capsulotomy was followed by an acute rise in IOP and resolution of the choroidal detachment. This response to the capsulotomy left no doubt that our speculation about the mechanism was correct.
Hypotony and ciliary body detachment can complicate extracapsular extraction in phakic or pseudophakic eyes.2
Orna Geyer MD
Moshe Lazar MD
bTel Aviv, Israel
1. Lanzl IM, Kopp C. Ciliary body detachment caused by capsular contraction. J Cataract Refract Surg 1999; 25:1412-1414
© 2000 by Lippincott Williams & Wilkins, Inc.
2. Geyer O, Godel V, Lazar M. Hypotony as a late complication of extracapsular cataract extraction. Am J Ophthalmol 1983; 96:112-113