Early postoperative capsular block syndrome related to saccadic-eye-movement-induced fluid flow into the capsular bag

Retro-intraocular Lens Irrigation-aspiration to Prevent Capsular Block Syndrome at the Hands of Novice Surgeons

Retro-intraocular lens (IOL) irrigation-aspiration is of paramount importance in order to remove the viscoelastic substance from the retro-IOL space and to prevent any early post-operative capsular block syndrome. However, manoeuvring the IOL to reach the retro-IOL space may be difficult at the hands of novice surgeons despite the use of coaxial or bimanual irrigation-aspiration probes. We describe a simpler and safer technique in order to facilitate the removal of this retro-IOL viscoelastic substance using a 26-Gauge bent-cannula mounted on a 2-ml syringe. The fluid is injected forcefully along with sideways movement of cannula in a single-plane to displace the viscoelastic substance.

Capsular block syndrome: a case report and literature review

PURPOSE

To report the case of a patient who developed late capsular block syndrome and to review the current literature regarding this complication of phacoemulsification procedures.

METHODS

The literature was reviewed to summarize the diagnosis, classification, use of diagnostic aids, and the current treatments for this complication.

RESULTS

A 69-year-old patient complained of decreased visual acuity 11 months after undergoing phacoemulsification. She was found to have a secondary myopization. Anterior segment ultrabiomicroscopy confirmed the diagnosis of capsular block syndrome. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy, which resulted in complete resolution of her symptoms.

CONCLUSION

CAPSULAR BLOCK SYNDROME IS A FAIRLY RARE COMPLICATION OF PHACOEMULSIFICATION PROCEDURES THAT, DEPENDING PRIMARILY ON THE TIMING OF ITS OCCURRENCE FOLLOWING SURGERY, CAN DEVELOP INTO ONE OF THE THREE FOLLOWING POSSIBLE CLINICAL SCENARIOS: intraoperatory, early postoperatory, and late postoperatory. In this patient, Nd:YAG laser capsulotomy was shown to be a safe and effective treatment option for this type of complication.

Late Postoperative Capsular Block Syndrome: A Case Series Studied before and after Nd:YAG Laser Posterior Capsulotomy

Purpose

To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of Nd:YAG laser posterior capsulotomy on visual acuity and refractive error as well as its possible complications.

Methods

In this retrospective cohort study, 12 eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete ophthalmic examination including Scheimpflug camera and anterior segment optical coherence tomography (AS-OCT) imaging had been performed before and after posterior capsulotomy.

Results

The mean time between cataract surgery and posterior capsulotomy was 4.7 ± 1.5 years (range 3-9 years). Best-corrected visual acuity increased in 11 cases (91.7%). Only one eye showed a 0.5-D hyperopic shift following posterior capsulotomy. There were no postlaser complications such as increased intraocular pressure (IOP), severe inflammation, cystoid macular edema, or retinal detachment. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. The AS-OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the intraocular lens (IOL).

Conclusions

Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement, or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Furthermore, although AS-OCT measurements are easier to obtain than rotating Scheimpflug imaging examination, both are useful to visualize the distended capsular bag containing the white material and the IOL position.

Detection and influencing factors of capsular bag distention syndrome after cataract surgery using the Pentacam Scheimpflug system

PURPOSE

To investigate the prevalence and morphologic changes of capsular bag distention syndrome after cataract surgery using the Pentacam and to analyze its clinical characteristics and influencing factors.

DESIGN

Retrospective, cross-sectional study.

METHODS

Clinical records of 239 consecutive patients who underwent cataract surgery were reviewed. Demographic data, use of intraoperative ophthalmic viscosurgical devices, type of intraocular lens implanted, axial length, and white-to-white corneal diameter were recorded. One month after surgery, dilated Scheimpflug imaging was performed. Prevalence, morphologic changes, and characteristic clinical findings of this syndrome were evaluated.

RESULTS

Using Scheimpflug imaging, the prevalence of capsular bag distention syndrome was high at 26.8% (64/239), and it was possible to classify its morphologic changes into 3 types. Patients with the syndrome had poorer best-corrected visual acuity and lower satisfaction scores than those without the syndrome (P = .041 and P = .008, respectively). Although there was no significant difference observed in rate of this syndrome between the 2 ophthalmic viscosurgical devices used in our study (P > .05), implantation of 4-haptic intraocular lenses was associated with a high prevalence of the syndrome (odds ratio, 2.07; 95% confidence interval, 1.05 to 4.07; P = .0346). Patients with this syndrome had significantly longer AL (26.26 ± 2.84 mm) and white-to-white diameter (12.02 ± 0.34 mm) than those without (AL, 24.63 ± 2.89 mm; white-to-white diameter, 11.81 ± 0.32 mm; P = .0002 and P < .0001, respectively).

CONCLUSIONS

Scheimpflug imaging revealed the prevalence of capsular bag distention syndrome to be high, and these patients generally had poorer visual outcomes. Intraocular lens design and dimensions of the eyes significantly influenced the prevalence of this syndrome.

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.

Intraoperative peripheral anterior capsulotomy to prevent early postoperative capsular block syndrome

We describe a new surgical technique, intraoperative peripheral anterior capsulotomy (IPAC), to prevent early postoperative capsular block syndrome (CBS). Eighty consecutive patients (80 eyes) had phacoemulsification and intraocular lens implantation with IPAC in the presence of a small (4.5 to 5.0 mm) anterior continuous curvilinear capsulorhexis (CCC). Patients were followed for a mean of 16 months (range 6 to 24 months), and none developed CBS or other complications. Our series suggests that IPAC may be an alternative to prevent CBS in high-risk eyes, including those with a small anterior CCC or ophthalmic viscosurgical device material trapped in the capsular bag. This surgical technique is safe, effective, inexpensive, and easy to perform.

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.