Complete capsular bag distension syndrome

LATE-ONSET CAPSULAR BAG DISTENSION SYNDROME: A REPORT OF TWO CASES

Capsular bag distension syndrome is a very rare complication of cataract surgery. Most cases occur after uneventful phacoemulsification with continuous curvilinear capsulorhexis and implantation of an intraocular lens in the capsular bag. The entity presents with reduction of visual acuity and myopic shift in the early-to-late postoperative period. Characteristic findings include the distension of the capsular bag due to the accumulation of milky material and the forward displacement of the intraocular lens. We present two cases with an unusually delayed presentation of 6 and 8 years respectively following phacoemulsification, and describe their successful management with Nd:YAG laser posterior capsulotomy.

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.

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 bag distension syndrome after combined cataract and glaucoma surgery

PURPOSE

To report four cases of capsular bag distension syndrome (CBDS) after combined cataract and glaucoma surgery.

METHODS

We describe the clinical features and evolution of each case after individual treatment.

CASE REPORTS

We report four cases of CBDS after phacoemulsification, combined with trabeculectomy in two cases and with an Ahmed aqueous drainage device implantation in the other two cases. The space between the intraocular lens (IOL) and the posterior capsule was occupied by an optically clear liquid in two cases and by a turbid liquid in the other two cases, with posterior bowing of the capsule into the anterior vitreous. A myopic shift and anterior chamber shallowing occurred in three cases. After posterior Nd:YAG laser capsulotomy, the CBDS resolved in three cases. In case 1, a surgical posterior capsulotomy and anterior vitrectomy were necessary.

DISCUSSION

Capsular bag distension syndrome should be included in the differential diagnosis of a shallow anterior chamber after combined cataract and glaucoma surgery.

Évaluation d’un syndrome de blocage capsulaire tardif avec l’OCT de segment antérieur

A year after routine phacoemulsification and insertion of a soft posterior chamber IOL, a 59-year-old woman developed progressive moderate myopia. A syndrome of late capsular block was diagnosed following biomicroscopic examination, which was treated by Nd YAG laser posterior capsulotomy. The myopia disappeared immediately. This observation was illustrated with optical coherence tomography (OCT) developed for the anterior segment. After capsulotomy, the IOL moved backwards by 448 microm, which corresponds exactly to a--1D induced myopia.

Assessment of capsular block syndrome with anterior segment optical coherence tomography

A 59-year-old woman developed progressive, moderate myopia 1 year after routine phacoemulsification and insertion of a soft posterior chamber intraocular lens (IOL). After biomicroscopy, late capsular block was diagnosed and treated with a neodymium:YAG laser posterior capsulotomy. The myopia disappeared immediately. This case was illustrated using optical coherence tomography developed for the anterior segment. After capsulotomy, the IOL moved backward by 448 microm, corresponding to -0.75 diopter of induced myopia.

Intraocular lens exchange assisted by preoperative neodymium:YAG laser haptic fracture

We present 3 cases of intraocular lens (IOL) exchange in which a neodymium:YAG (Nd:YAG) laser was used before surgery to fracture a haptic and make intraocular manipulations easier and safer. Strategic placement of the fracture facilitates maneuvering to explant the IOL segments. Delaying pupil dilation until after the Nd:YAG laser is used and prudent positioning of the patient's head minimize the risk that freed IOL segments will damage the cornea or subluxate posteriorly into the vitreous cavity. Neodymium:YAG laser IOL fracture before explantation/ exchange is a viable combined procedure.