Capsular block syndrome with external blockage of the capsular opening by a ciliary sulcus fixated posterior chamber lens

Nonarteritic ischemic optic neuropathy developed after capsular block syndrome

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.

Scheimpflug imaging of ultra-late postoperative capsular block syndrome

PURPOSE

To report the clinical findings of three cases with ultra-late postoperative capsular block syndrome (CBS) by Pentacam Scheimpflug imaging.

METHODS

Case series.

RESULTS

Three cases of ultra-late postoperative CBS are presented.

DISCUSSION

This report highlights the importance of conducting Pentacam Scheimpflug imaging in late CBS. Each case either enhanced our understanding or improved our differential diagnosis of late CBS.

Imaging late capsular bag distension syndrome: an anterior segment optical coherence tomography study

Background

Anterior segment optical coherence tomography (ASOCT) was used to categorize and provide insights into the etiology of capsular bag distension syndrome (CBDS).

Methods

A prospective review was undertaken of 10 cases who presented with signs of late CBDS 5–11 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation.

Results

All 10 patients presented with a milky collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. ASOCT was used to confirm the diagnosis in all cases, and a hyperintense signal was seen in the space between the posterior chamber intraocular lens and the posteriorly bowed posterior capsule. The continuous curvilinear capsulorhexis was measured to be between 3.18 mm and 4.70 mm. Three cases had uncorrected visual acuity better than 6/12. Uncomplicated Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in eight patients, with no resulting change in the intraocular lens position (measured by ASOCT) or subjective refraction.

Conclusion

Our study showed that ASOCT is a useful modality to differentiate this condition clearly from posterior chamber intraocular lens opacification and to investigate its causation. Nd:YAG posterior capsulotomy proved to be a safe and successful treatment for late CBDS with no change in biometric or refractive parameters.

Photographic essay. Anterior segment optical coherence tomography findings of early capsular block syndrome

Capsular block syndrome (CBS) or capsular bag distension syndrome is characterized by distension of the capsular bag after uneventful phacoemulsification and endocapsular intraocular lens implantation. The syndrome has also been reported after extracapsular cataract extraction and intraocular lens placed in the sulcus. We report the anterior segment optical coherence tomographic findings in a case of early postoperative CBS. Anterior segment optical coherence tomographic aids in the diagnosis and management of CBS.

Late-onset hyaloideocapsular block syndrome

PURPOSE

To report an unusual cause of decreased vision in an aphakic patient.

DESIGN

Interventional case report.

PARTICIPANT

One patient.

INTERVENTION

An 80-year-old woman presented with a myopic shift and decreased visual acuity in the left eye 16 years after extracapsular cataract extraction (ECCE) without intraocular lens (IOL) implantation. Slit-lamp examination after pupil dilation revealed a milky fluid accumulation between the posterior lens capsule and the anterior hyaloid membrane. A neodymium:yttrium-aluminium-garnet (Nd:YAG) laser hyaloidotomy was performed on the anterior hyaloid membrane.

MAIN OUTCOME MEASURES

Refraction and best-corrected visual acuity.

RESULTS

The Nd:YAG laser hyaloidotomy allowed the trapped fluid to flow into the vitreous cavity. The myopic shift disappeared immediately and visual acuity improved.

CONCLUSIONS

To our knowledge, this is the first report of a late-onset hyaloideocapsular block syndrome after ECCE without IOL implantation.

Phacoanaphylactic endophthalmitis secondary to capsular block syndrome

A 65-year-old white man presented with sudden onset of painless decrease in vision and a red eye 5 days after cataract surgery. The visual acuity was 20/400 with mild injection. Marked iritis was present, and a hypopyon could be seen behind the intraocular lens (IOL) in the capsular bag. The posterior segment was clear. The iritis worsened despite 4 days of hourly topical corticosteroid treatment. Anterior chamber washout was performed, with clearing of the material behind the IOL. The iritis subsided 4 weeks later, and visual acuity recovered to 20/20. Capsular block syndrome can present as phacoanaphylactic endophthalmitis if cortical material is left in the capsular bag, requiring surgical intervention.

Incomplete capsular bag distension syndrome after neodymium:YAG capsulotomy

We report a 60-year-old man with incomplete capsular bag distension syndrome 2 years after neodymium:YAG (Nd:YAG) laser capsulotomy for capsule opacification, which developed from extracapsular cataract extraction with intraocular lens (IOL) implantation performed 4 years before presentation to our clinic. The patient reported floaters of 15 days duration. Slitlamp examination showed shallowing of the inferior and medial anterior chamber. Dilated pupil examination showed a peripheral capsular bag inferiorly and medially behind the IOL. The bag was distended and filled with turbid fluid. The central and superior capsule was absent as a result of the previous Nd:YAG treatment. The IOL lie over the anterior capsule, and peripheral capsule leaves' edges were adhered. An Nd:YAG laser puncture of the incomplete capsular bag resolved the condition.

Capsular block syndrome caused by a reversed-optic intraocular lens

A 52-year-old man who had phacoemulsification and in-the-bag fixation of a posterior chamber intraocular lens (IOL) developed capsular block syndrome 1 day after reverse implantation of the IOL. After a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy, the distended capsular bag collapsed significantly and the artificial myopia partially resolved. An Nd:YAG laser peripheral anterior capsulotomy appeared to be an effective, simple, and minimally invasive method to treat this problem.

Capsular block syndrome associated with horizontal jerk nystagmus

A 78-year-old cataract patient with horizontal jerk nystagmus had phacoemulsification and intraocular lens (IOL) implantation in the capsular bag with continuous curvilinear capsulorhexis. One week postoperatively, the posterior capsule ballooned posteriorly, the anterior capsule opening was sealed to the IOL optic, and a transparent liquefied substance accumulated between the lens optic and the posterior capsule. The best corrected visual acuity was 0.6 with a myopic shift compared with the refraction after the first day. A neodymium:YAG laser posterior capsulotomy was performed, and the capsular block syndrome (CBS) resolved. The results confirm the experimental model proposed by Zacharias suggesting that saccadic eye movements contribute to CBS under certain anatomic conditions.

Capsular block syndrome associated with secondary angle-closure glaucoma

An 83-year-old man who had phacoemulsification and ciliary sulcus fixation of a posterior chamber intraocular lens developed capsular block syndrome with secondary glaucoma 1 year after surgery. The glaucoma resolved, and vision returned immediately after a neodymium:YAG laser capsulotomy was performed. Capsular block syndrome with secondary angle-closure glaucoma should be considered in pseudophakic patients presenting with increased intraocular pressure and a narrow angle.

Early postoperative capsular block syndrome

PURPOSE

To report the results of early postoperative capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation.

SETTING

Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey.

METHODS

Thirteen eyes of 13 patients with CBS who had uneventful phacoemulsification were included in the study. Twelve patients had in-the-bag implantation of a foldable IOL, and 1 had implantation of a poly(methyl methacrylate) IOL in the ciliary sulcus. Continuous curvilinear capsulorhexis was performed in all eyes, and sodium hyaluronate 1.4% (Healon GV(R)) was used during all steps of surgery. The patients were closely followed without intervention during the first month after surgery. If resolution did not occur during follow-up, a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy was performed first, followed by posterior capsulotomy if the anterior capsulotomy was not successful.

RESULTS

The CBS resolved without intervention in 2 eyes by 1 month postoperatively. A small Nd:YAG laser peripheral anterior capsulotomy was attempted in 10 cases after 1 month but could not be performed in 2 eyes because of inadequate pupil dilation. Peripheral anterior capsulotomy was successful in 5 of 8 eyes, with resolution of CBS in a few days. The Nd:YAG laser posterior capsulotomy was successful in 5 cases after the failure of the anterior capsulotomy. One patient chose to postpone treatment for 11 months, at which time posterior capsulotomy was performed successfully and the CBS resolved.

CONCLUSIONS

Resolution of CBS occurred spontaneously in only a small percentage of cases during the first month after phacoemulsification with IOL implantation. Neodymium:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating CBS.

Early capsular distension syndrome after sulcus implantation of intraocular lenses

Two cases of early capsular distension syndrome (cds) are presented. the first occurred after sulcus implantation of a 12.0 mm poly(methyl methacrylate) iol (5.0 mm optic, 10 degree anterior angulation). the second case occurred after sulcus implantation of a foldable silicone iol with optic capture (6.0 mm optic, no anterior angulation). both cases resolved after a neodymium:YAG laser anterior capsulotomy. Cataract surgeons should be aware of the possibility of CDS after sulcus implantation of an IOL in the presence of an intact capsulorhexis and posterior capsule. A small capsulorhexis and in-the-bag capture of the IOL optic are major predisposing factors in this setting.