Case Report: Resolution of negative dysphotopsia after capsulorhexis revision in an extended depth of focus intraocular lens.

Negative dysphotopsia (ND) is a known cause of patient dissatisfaction following cataract surgery with intraocular lens (IOL) implantation. While IOL explantation is often considered in persistent cases, identifying reversible anatomical factors is essential to minimize surgical risk. Capsulorhexis size and configuration have been implicated in the pathogenesis of ND but remain underrecognized as a direct therapeutic target. A 73-year-old woman underwent uncomplicated phacoemulsification with implantation of an extended depth of focus (EDOF) IOL in the left eye. Postoperatively, she experienced persistent negative dysphotopsia despite optimal visual acuity, which significantly impacted her daily activities. At 6 months, she was referred to a university hospital where IOL explantation was recommended. On presentation to our department for a second opinion, slit-lamp examination revealed optimal IOL centration but a markedly small and irregular capsulorhexis. No posterior capsule defect, opacification, or refractive error was noted. The patient underwent surgical enlargement of the anterior capsulorhexis and removal of fibrotic capsular tissue using microsurgical scissors. The IOL remained stable, and no intraoperative complications occurred. Postoperatively, the patient reported progressive improvement in visual quality. At the 1-month follow-up, negative dysphotopsia had resolved, visual acuity remained stable, and patient satisfaction was high, avoiding the need for IOL explantation. Small or irregular capsulorhexis can be an underrecognized and reversible cause of IOL intolerance. Surgical revision of capsulorhexis may represent a safe and effective, lens-preserving alternative to IOL explantation in selected patients. Careful anterior segment evaluation should be considered in the diagnostic workup of postoperative dysphotopsia to identify candidates for this targeted intervention. This approach may be considered prior to IOL explantation in the management of persistent negative dysphotopsia.