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Yang HY, Kao SC, Tsai CC, Yu WK. Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics. J Chin Med Assoc 2022; 85:799-803. [PMID: 35648136 DOI: 10.1097/jcma.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Hsin-Yu Yang
- Taipei Veterans General Hospital Yuanshan and Suao Branch, Yilan, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Sui-Ching Kao
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Kuang Yu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Al-Mulla AH, Al-Rushoud MW. Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis. Cureus 2021; 13:e19684. [PMID: 34934563 PMCID: PMC8683699 DOI: 10.7759/cureus.19684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
Abstract
This report describes an unusually delayed presentation of capsular bag distension syndrome (CBDS), which was found to be associated with Propionibacterium acnes (P. acnes) endophthalmitis. Our patient presented with a gradual decrease in vision after uneventful cataract surgery done 13 years back. On examination, there was a thick turbid fluid entrapped behind the intraocular lens (IOL). Ultrasound biomicroscopy (UBM) confirmed the presumed diagnosis. The case was managed by pars plana vitrectomy (PPV) with posterior capsulotomy, and the entrapped turbid fluid was aspirated and sent for histopathology, which revealed a positive growth of P. acnes. The patient had excellent outcomes with complete resolution post-operatively.
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Affiliation(s)
| | - Muath W Al-Rushoud
- Department of Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, SAU
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Abstract
Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery due to collection of fluid behind the intraocular lens (IOL). Nd:Yag laser capsulotomy is commonly performed to release the fluid collection; however, the potential risk of infection and inflammation has led to adaptation of numerous surgical procedures. Clinical examination in an established case of CBDS reveals opalescent fluid behind the IOL with ballooning of the posterior capsule, which has different reflectivity on optical coherence tomography. However, the exact optical properties of this fluid are still unknown. A case of delayed CBDS with induced myopia due to change in IOL position because of fluid collection behind the IOL is presented.
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Lin Y, Lin J, Su Z, Chen Z, Yao K. Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy. Am J Ophthalmol 2019; 204:19-25. [PMID: 30849349 DOI: 10.1016/j.ajo.2019.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the clinical characteristics of eyes affected by late postoperative capsular block syndrome (CBS) after routine phacoemulsification or phacovitrectomy, and to demonstrate the outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy and posterior continuous curvilinear capsulorrhexis (PCCC) in the treatment of CBS. DESIGN Retrospective interventional case series study. METHODS Twenty-eight patients with late postoperative CBS, comprising 13 eyes after phacoemulsification (Group A) and 15 eyes after phacovitrectomy (Group B), were analyzed. Seventeen patients with minimal (degree I), mild (II), and moderate (III) posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy (Group A, 10 eyes and Group B, 7 eyes), while 11 patients with severe (degree IV) PCO underwent PCCC (Group A, 3 eyes and Group B, 8 eyes). RESULTS A statistically significant postoperative improvement in best-corrected visual acuity (Group A, P = .0002 and Group B, P = .0070) and a significant postoperative decrease in aqueous flare value (Group A, P = .0077 and Group B, P = .0127) were observed. No significant differences were observed in intraocular pressure, aqueous depth, and diopters (P > .05). No surgical complications were experienced by either group. CONCLUSIONS Late postoperative CBS had similar characteristics whether it developed after phacoemulsification or after phacovitrectomy. Nd:YAG capsulotomy and the PCCC technique are efficient approaches to mild and moderate PCO and severe PCO with CBS, respectively. PCCC may be a viable alternative for treating dense PCO with CBS in pseudophakic eyes.
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Affiliation(s)
- Yuchen Lin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jijian Lin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhitao Su
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Plemel DJA, Benson MD, Rayat JS, Greve MDJ, Tennant MTS. Capsular block syndrome 20 years post-cataract surgery. Can J Ophthalmol 2018; 53:e222-e224. [PMID: 30502997 DOI: 10.1016/j.jcjo.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/25/2022]
Affiliation(s)
- David J A Plemel
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Matthew D Benson
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta.
| | - Jaspreet S Rayat
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Mark D J Greve
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Matthew T S Tennant
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
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Ahn MW, Kim SH, Lee JS. A Case of Late-onset Capsular Block Syndrome, Resulting in the Misdiagnosis of Intraocular Lens Opacity. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.6.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Won Ahn
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - So Hee Kim
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Outcome of Surgical Treatment in Late-Onset Capsular Block Syndrome. J Ophthalmol 2017; 2017:1847179. [PMID: 28770106 PMCID: PMC5523514 DOI: 10.1155/2017/1847179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/03/2017] [Accepted: 04/18/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose To further investigate the pathogenesis of late-onset capsular block syndrome (CBS) and to evaluate the safety of surgical treatment. Methods Seven patients diagnosed with late-onset CBS were retrospectively analyzed. Anterior chamber depth (ACD), intraocular pressure (IOP), refractive diopter, and best-corrected visual acuity (BCVA) before and after surgery were recorded. The opaque substance was tested with Western blot, and a flow cytometer multiple array assay system was utilized to evaluate the levels of inflammatory cytokines from opaque substance and aqueous humor, respectively. Results Patients who had undergone surgical treatment showed a significant BCVA and spherical equivalent refractive error improvement (P = 0.002, P = 0.021, resp.). Nevertheless, ACD and IOP before and after surgery were in normal range with no difference (P = 0.165, P = 0.749, resp.). αB-crystallin and βB-crystallin were detected in all opaque substances. Tumor necrosis factor-alpha (TNF-α) and interlukin-1β (IL-1β) levels in opaque substance were significantly higher than those in aqueous humor (P = 0.038, P = 0.007, resp.), while IL-2 and IL-6 were not detected in any samples. Conclusions Opaque substance is derived from human lens epithelial cells. Inflammatory cytokines may be involved in the pathogenesis of late-onset CBS. In addition, surgical treatment is an effective approach. This trial is registered with ChiCTR-IOR-17011287.
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Zafeiropoulos P, Katsanos A, Gorgoli K, Asproudis I, Aspiotis M. LATE-ONSET CAPSULAR BAG DISTENSION SYNDROME: A REPORT OF TWO CASES. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 57:165-7. [PMID: 25938901 DOI: 10.14712/18059694.2015.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Son GS, Kim MJ, Chung HJ, Chung YS, Choi JY. A Case of Malignant Glaucoma in a Vitrectomized Eye. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.4.638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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