{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:40:11Z","timestamp":1756100411146,"version":"3.44.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the mechanism, intraoperative characteristics, management, and prevention of incision capsular bag herniation (ICBH), a previously unreported complication during cataract surgery in eyes with lens subluxation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective observational case series was conducted on five male patients who developed ICBH during phacoemulsification with intraocular lens (IOL) implantation between January 2019 and December 2024. Among 867 subluxated-lens surgeries performed during this period, the estimated incidence of ICBH was 0.58%. Clinical data was reviewed to identify predisposing factors and outcomes. Each case was managed through a stepwise intraoperative process consisting of IOP reduction, capsular decompression, capsular bag repositioning, and anterior vitrectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ICBH occurred adjacent to the main corneal incision near areas of 1\u20132 quadrants of zonular dialysis. Triggers included IOL injector insertion (2 cases), ophthalmic viscosurgical device (OVD) injection (1 case), and aspiration tip withdrawal (2 cases). Contributing factors included elevated IOP and sudden decompression. The herniated tissue comprised an OVD-distended capsular bag with vitreous incarceration. The stepwise protocol led to successful capsular repositioning and in-the-bag IOL implantation in all cases. Best-corrected visual acuity improved from a preoperative range of 1.3 to 0.3 logMAR (median, 0.5) to a postoperative range of 0.7 to 0.0 logMAR (median, 0.1). No IOL decentration occurred. One case each of cystoid macular edema and choroidal detachment was noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ICBH results from zonular weakness, incision location, IOP fluctuation, OVD dynamics, and capsular biomechanics. With appropriate intraoperative management, favorable outcomes are achievable. Prevention includes zonular assessment, incision planning, and pressure control. Further studies are needed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1647413","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:25:30Z","timestamp":1756099530000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incision capsular bag herniation during subluxated lens surgery: mechanisms, management, and prevention"],"prefix":"10.3389","volume":"12","author":[{"given":"Shuang","family":"Ni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danni","family":"Lyu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxia","family":"Fang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1016\/j.jcrs.2013.09.005","article-title":"Management of the subluxated crystalline lens","volume":"39","author":"Hoffman","year":"2013","journal-title":"J Cataract Refract Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2432","DOI":"10.4103\/ijo.IJO_255_22","article-title":"Outcomes of surgical intervention in cases of ectopia lentis","volume":"70","author":"Maharana","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.aopr.2024.08.002","article-title":"Research progress on the impact of cataract surgery on corneal endothelial cells","volume":"4","author":"Yang","year":"2024","journal-title":"Adv Ophthalmol Pract Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1111\/ceo.13975","article-title":"Management of the subluxated crystalline lens: a review","volume":"49","author":"Chee","year":"2021","journal-title":"Clin Experiment Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/ICU.0b013e3282f2ccc8","article-title":"Surgical strategies for the management of zonular compromise","volume":"19","author":"Blecher","year":"2008","journal-title":"Curr Opin Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/ICU.0000000000000118","article-title":"All about capsular tension rings","volume":"26","author":"Weber","year":"2015","journal-title":"Curr Opin Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1111\/j.1600-0420.2007.00901.x","article-title":"Management of large traumatic zonular dialysis with phacoemulsification and Iol implantation using the capsular tension ring","volume":"85","author":"Georgopoulos","year":"2007","journal-title":"Acta Ophthalmol Scand"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jcrs.2005.08.062","article-title":"Intraocular pressure during phacoemulsification","volume":"32","author":"Khng","year":"2006","journal-title":"J Cataract Refract Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/S1350-9462(03)00063-6","article-title":"Mechanical properties of the human lens capsule","volume":"22","author":"Krag","year":"2003","journal-title":"Prog Retin Eye Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/s40123-021-00403-9","article-title":"Ophthalmic Viscosurgical devices (Ovds) in challenging cases: a review","volume":"10","author":"Borkenstein","year":"2021","journal-title":"Ophthalmol Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/ICU.0000000000000113","article-title":"Intraoperative management of posterior capsular rupture","volume":"26","author":"Hong","year":"2015","journal-title":"Curr Opin Ophthalmol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1159\/000455280","article-title":"Postsurgical cystoid macular edema","volume":"58","author":"Zur","year":"2017","journal-title":"Dev Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1038\/sj.eye.6702742","article-title":"Management of glaucoma in patients with nanophthalmos","volume":"22","author":"Yalvac","year":"2008","journal-title":"Eye"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1647413\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:25:34Z","timestamp":1756099534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1647413\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":13,"alternative-id":["10.3389\/fmed.2025.1647413"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1647413","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"article-number":"1647413"}}