Capsular phimosis following phacotrabeculectomy.

Three cases of severe capsular phimosis following augmented phacotrabeculectomy complicated by intense postoperative fibrinous uveitis are described. The marked inflammation was possibly related to the combined procedure itself, the excessive intraoperative manipulation to stretch the pupil, and the compromised blood-aqueous barrier after prolonged use of pilocarpine. The combination of fibrinous uveitis and the small size of capsulorhexis attained through a stretched pupil are possible risk factors for developing severe capsular phimosis in the absence of zonular weakness or preoperative uveitis. For patients with similar risk factors, two separate surgical procedures should be considered. Alternatively, a larger capsulorhexis or radial relieving incisions should be attempted during phacotrabeculectomy to prevent this complication, which could jeopardize the outcome of otherwise successful surgery.