Capsular block syndrome 20 years post-cataract surgery

Late-onset capsular bag distension syndrome 33 years after cataract surgery

Purpose

Describe the clinical features and management of this uncommon case of late-onset Capsular bag distension syndrome that occurred 33 years after cataract surgery.

Observation

An 87-year-old male was referred to our clinic complaining of blurred and gradual, painless reduction in vision in his left eye over the past year. A complete ophthalmological examination, Ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (AS-OCT), and optical biometry were performed to confirm the diagnosis. A 25-gauge pars plana vitrectomy combined with posterior capsulotomy was performed. The aspirated fluid was sent for microbiological analyses. After surgery, the patient's visual acuity returned to previous values, and anterior chamber depth slightly deepened. Samples taken were negative for bacteria.

Conclusions and Importance

Late-onset Capsular bag distension syndrome may occur up to 33 years following cataract surgery. A surgical approach offers the advantage of complete clearance of the turbid fluid, also removing the residual cortical material and enabling microbial and pathological testing.

Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics

BACKGROUND

Late capsular blockage syndrome (CBS) is a rare phenomenon which is found after cataract surgery. The mechanism, anterior segment optical coherence tomography (OCT) presentation, and clinical characteristics are not well studied.

METHODS

We studied patients who developed late CBS in Taipei Veterans General Hospital from 2012 to 2019. Age, sex, systemic disease, ocular disease, interval between cataract surgery and CBS, axial length, type of intraocular lens implanted, grading of posterior capsular opacity, refraction, visual acuity, and anterior segment OCT findings were documented. Patients are categorized into two groups according to anterior segment OCT findings. All patients underwent Nd:YAG laser capsulotomy and were prescribed a low-dose topical steroid for 7 days. Postcapsulotomy refraction and visual acuity were recorded. All the clinical data were compared in the two groups.

RESULTS

This study included 18 eyes with late CBS. Patients' median age was 80 (range, 54-92) years. The mean duration between cataract surgery and CBS diagnosis was 80.28 (range 15-136) months. According to anterior segment OCT findings, we subcategorized the patients into two groups: gravel appearance (n = 7) and milky (n = 11) appearance. After laser capsulotomy, mean visual acuity improved 0.18 ± 0.10 on the LogMAR. A significant myopic shift in refraction after laser capsulotomy was noted in the gravel appearance group compared to the milky appearance group ( p = 0.027). No patient developed complications or needed further treatment for CBS during the median follow-up of 14.5 months (range 1-84 months).

CONCLUSION

High-resolution anterior segment OCT is useful for analyzing patients with late CBS. Our study implies that the two types of CBS presentation indicate different causes of late CBS formation, as well as distinct clinical presentation and postlaser capsulotomy refractive outcome. In addition, YAG laser capsulotomy is a safe late CBS treatment modality.

Case Series: Late Postoperative Capsular Block Syndrome Causing Reduced Vision Years After Uncomplicated Cataract Surgery

SIGNIFICANCE

Late postoperative capsular block syndrome is a treatable complication presenting months to years after cataract surgery using continuous curvilinear anterior capsulorhexis and a posterior chamber intraocular lens implantation. Patients may present to optometric practices because of symptom onset significantly after the immediate post-operative period.

PURPOSE

The purpose of this study was to describe the defining clinical features, proposed pathophysiology, and treatment of late postoperative capsular block syndrome. Case 1 was a 68-year-old man who presented with a sudden onset of blurry vision in the right eye 2 years after uncomplicated cataract surgery. Clinical examination revealed turbid fluid distending the posterior lens capsule, a 2-D myopic shift, and an absence of intraocular inflammation. Laser posterior capsulotomy successfully released the trapped fluid and reversed the myopic shift without complication. Case 2 was a 67-year-old man who presented with a gradual onset of hazy vision in the right eye 7 years after uncomplicated cataract surgery. Cloudy fluid was observed to be filling the space between the intraocular lens and the posterior lens capsule, and the refractive error was stable. The fluid was liberated and visual function was restored with uncomplicated laser posterior capsulotomy.

CONCLUSIONS

Patients with late postoperative capsular block syndrome may present with blurry vision months to years after cataract surgery performed with continuous curvilinear capsulorhexis and posterior capsule intraocular lens implantation. The defining clinical sign is entrapment of turbid fluid between the intraocular lens and the posterior capsule that may result in reduced vision or refractive error shift. Late postoperative capsular block syndrome is distinguishable from other late complications of cataract surgery, including delayed endophthalmitis or phacoantigenic uveitis, by lack of concurrent robust ocular inflammation.

Virtual Eye Simulation: An Aid in Evaluation of Capsular Block Syndrome

Objective:

To demonstrate the findings of three consecutive cases of postoperative Capsular Block Syndrome (CBS) diagnosed with the aid of Pentacam virtual eye simulation images.

Methods:

Observational case series report. Three patients underwent uneventful cataract removal and presented with blurry vision ranging from 4 days to 5 years after the surgeries were performed.

Results:

In a case of early-onset postoperative CBS, virtual eye simulation images clearly revealed a reduced posterior chamber depth caused by the accumulation of transparent fluid in the area between the intraocular lens and the posterior capsule. In two cases of late-onset postoperative CBS, virtual eye simulation images better visualized the alignment between intraocular lens (IOL) and iris than slit lamp examination and Schiemflug images. All three of the cases underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, and their capsular bag distensions were resolved immediately. The patients with misalignments between IOL and iris experienced more improvement in best-corrected visual acuity as opposed to the one who did not.

Conclusion:

Virtual eye simulation is found to be a useful way in visualizing misalignment between IOL and iris and assisting diagnoses of both early- and late-onset postoperative capsular block syndrome.