Newer IOL formulas include more anterior segment parame- ters, and accurate measurement of these parameters, including LT, is crucial for minimizing refractive errors. Thus, the results of optical biometry should be carefully evaluated. Tatsuhiko Sato, Junya Yamamoto, Shunsuke Shibata, Ken Hayashi Hayashi Eye Hospital, Fukuoka, Japan Originally received Aug. 8, 2019. Final revision Jan. 15, 2020. Accepted Mar. 24, 2020. Correspondence to: Tatsuhiko Sato, MD, PhD; tatsusatou@gmail.com. References 1. Leitgeb R, Hitzenberger C, Fercher A. Performance of fourier domain vs. time domain optical coherence tomography. Opt Express 2003;11:889–94. 2. Srivannaboon S, Chirapapaisan C, Chonpimai P, Loket S. Clinical comparison of a new swept-source optical coherence tomography-based optical biometer and a time-domain optical coherence tomography-based optical biometer. J Cata- ract Refract Surg 2015;41:2224–32. 3. Huang J, Chen H, Li Y, et al. Comprehensive comparison of axial length measurement with three swept-source OCT- based biometers and partial coherence interferometry. J Refract Surg 2019;35:115–20. 4. Bullimore MA, Slade S, Yoo P, Otani T. An evaluation of the IOLMaster 700. Eye Contact Lens 2019;45:117–23. 5. Sato T, Shibata S, Yoshida M, Hayashi K. Short-term dynam- ics after single- and three-piece acrylic intraocular lens implantation: a swept-source anterior segment optical coher- ence tomography study. Sci Rep 2018;8:10230. 6. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420–8. 7. Muller R, Buttner P. A critical discussion of intraclass correla- tion coefficients. Stat Med 1994;13:2465–76. Footnotes and Disclosure We would like to thank Editage (www.editage.com) for English language editing. The authors have no proprietary or commercial interest in any materials discussed in this article. Modified neodymium-doped yttrium aluminium garnet laser capsulotomy for complete anterior capsular contraction syndrome Anterior capsular contraction syndrome (ACCS) is defined as an exaggerated reduction of the capsular bag diameter, as a result of the contact between residual lens epithelial cells and intraocular lens (IOL), on the edge of continuous curvi- linear capsulorhexis. It is a well-known but rare complica- tion after uneventful cataract surgery. 1 The aetiology remains unclear. However, a number of factors have been associated, including small rhexis (<4 mm diameter), pseudoexfoliation, uveitis, high myopia, retinitis pigmentosa, myotonic dystrophy, and diabetes. 1 Additionally, IOL biomaterial and design are well-estab- lished related factors. 2 Silicone IOLs are known to lead to a greater degree of capsular contraction than acrylic IOLs. ACCS typically occurs within the first 3 postoperative months. The degree of phimosis can be significant enough to displace IOL causing secondary refractive shift or occlude the visual axis and reduce vision. Both require anterior cap- sulotomy either with a neodymium-doped yttrium alumin- ium garnet (Nd:YAG) laser or surgically. 2 We report a case of anterior capsular contraction with com- plete occlusion of the visual axis. Treatment with Nd:YAG laser was performed after a C-shaped superior arcuate pattern. A 65-year-old woman presented to our institution, com- plaining of gradual deterioration of vision in her right eye. Written consent was obtained from the patient. Four months before her visual symptoms, she had undergone uneventful cataract surgery. A monofocal, single-piece, hydrophilic IOL (RayOne, Rayner, Ltd) was implanted at the time of surgery. She was otherwise fit and well with no ocular history. On examination, her best-corrected visual acuity was RE 6/ 60 and LE 6/6. Slit-lamp biomicroscopy revealed marked thickening of the anterior capsule with capsular contraction and complete occlusion of the capsulorhexis opening (Fig. 1). Anterior chamber (AC) was deep and quiet without any signs of uveitis or zonular weakness. Anterior segment opti- cal coherence tomography showed a central thick hyper- reflective band placed between the iris plane and IOL, occluding the visual axis (Fig. 2). Our primary approach was an Nd:YAG laser anterior capsu- lotomy. Initial attempts to laser the central thick membrane in a cross-shaped pattern failed. Despite higher energy settings, the laser did not penetrate the thickened anterior fibrosis. Sub- sequently an arcuate Nd:YAG laser capsulotomy was success- fully performed. This involved directing laser shots to the peripheral anterior capsule in a C-shaped 200-degree pattern starting superiorly (Fig. 1, red hemicircle). This anterior capsu- lotomy configuration resolved contraction and displaced the thick opacity inferiorly. One month after laser treatment, visual acuity improved to 6/6 unaided, the IOL remained stable, and no recurrence of phimosis noted. Subsequent review at 6 and 12 months showed a similar clinical picture with unaided vision of 6/6 maintained, and the capsulotomy site remained clear (Fig. 1). Can J Ophthalmol Volume 55, Number 5, October 2020 e168