A case of late-onset capsular block syndrome and its surgical treatment

Bergamo, Vinicius Campos; Nakayama, Luis Filipe; Yamada, Verônica Haysa; Marujo, Fábio Iglesias

doi:10.5935/0004-2749.20190030

Cited by 5 publications

(5 citation statements)

References 8 publications

(18 reference statements)

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“…And third, having the associated symptoms of recurrent mild pain, photophobia, and redness with the dramatic resolution of these symptoms after the surgical management. To the best of the author's knowledge, up to date, there is only one reported case that described CBDS development after 14 years [ 4 ], and only two described it after 13 years (as in our patient) [ 8 , 9 ]. Upon careful examination of the anterior segment with maximal dilation, it was noted that the capsulorhexis of the OS was small (4.7 mm) compared to the OD (5.5 mm), which explains the unilateral involvement in our case.…”

Section: Discussionmentioning

confidence: 90%

Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis

Al-Mulla¹,

Al-Rushoud²

2021

Cureus

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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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Section: Discussionmentioning

confidence: 90%

Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis

Al-Mulla¹,

Al-Rushoud²

2021

Cureus

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“…described a technique of injecting dispersive ophthalmic viscosurgical device (OVD) between the IOL and the posterior capsule to displace the milky CBS fluid into the anterior chamber, then removing both the OVD and CBS fluid with an irrigation/aspiration handpiece. [ 19 ] Nd: YAG laser capsulotomy was performed thereafter to prevent CBS recurrence. [ 19 ] Needle aspiration of the CBS fluid by inserting the needle through the anterior capsule between the IOL and posterior capsule via a corneal or scleral tunnel, followed by removal of adherent anterior capsular fibrosis and irrigation and aspiration has also been described.…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 ] Nd: YAG laser capsulotomy was performed thereafter to prevent CBS recurrence. [ 19 ] Needle aspiration of the CBS fluid by inserting the needle through the anterior capsule between the IOL and posterior capsule via a corneal or scleral tunnel, followed by removal of adherent anterior capsular fibrosis and irrigation and aspiration has also been described. [ 12 , 13 ] In our case where the patient presented 16 years postcataract surgery, release of the IOL from the fibrotic anterior capsule would have been challenging with either of these techniques, with inherent risks of inadvertent capsular bag tear or rupture and IOL damage from the needle.…”

Section: Discussionmentioning

confidence: 99%

Femtosecond laser-assisted posterior capsulotomy for the treatment of capsular block syndrome

Mehta,

Lim,

Patil

2023

Taiwan J Ophthalmol

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We present a novel use of femtosecond laser to treat capsular block syndrome (CBS) in a patient with dense opaque capsular block, who presented 16 years postcataract surgery. The extensive posterior capsular distension and densely opaque, milky fluid trapped behind the intraocular lens (IOL) prevented the use of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser posterior capsulotomy as primary treatment. Intra-operative optical coherence tomography enabled visualization of the posterior capsule and iris hooks were used to increase the pupillary diameter to enable femtosecond laser-assisted posterior capsulotomy to be performed in a minimally invasive technique. CBS was relieved successfully and Nd: YAG laser performed subsequently to remove residual posterior capsule opacification safely and with good visual outcomes. This method avoids risks associated with posterior vitrectomies and compromised IOL stability from inadvertent capsular bag damage, and adds to the expanding uses of femtosecond laser technology.

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“…Gilhotra et al 18 and Koh et al 25 reported recurrence of CBS 1 week and 10 months after YAG capsulotomy, respectively. Capsular fluid aspiration 5,6,26 and vitrectomy 7,12 can be performed if laser treatment fails 7 for refractory cases, or cases that need specimens for analysis. All our patients, no matter which type in anterior segment OCT, received laser capsulotomy without complications, and mean visual acuity improved by 0.18 ± 0.10 on the LogMAR.…”

Section: Discussionmentioning

confidence: 99%

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

Yang

Kao

Tsai

et al. 2022

Journal of the Chinese Medical Association

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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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A case of late-onset capsular block syndrome and its surgical treatment

Cited by 5 publications

References 8 publications

Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis

Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis

Femtosecond laser-assisted posterior capsulotomy for the treatment of capsular block syndrome

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

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