Capsular block syndrome: a case report and literature review

Abstract

PurposeTo report the case of a patient who developed late capsular block syndrome and to review the current literature regarding this complication of phacoemulsification procedures.MethodsThe literature was reviewed to summarize the diagnosis, classification, use of diagnostic aids, and the current treatments for this complication.ResultsA 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.ConclusionCapsular 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.

Ultra-Late Onset Capsular Bag Distension Syndrome: Risk Factors and Characteristics on Scheimpflug Imaging

“…Different factors but similar mechanism appears the cause for late onset CBDS as in our cases. Presence of fibrous capsular opacification due to residual lens epithelial proliferation in these cases supported the theory of late fibrotic reaction for CBDS [11]. Proliferation of lens epithelial cells causes accumulation of protein and oncotic material leading to fluid collection in the retrolenticular space.…”

“…Other imaging modalities like anterior segment optical coherence tomography (AS-OCT) or ultrasound biomicroscopy (UBM) have also been described for the detection of CBDS, but less sensitive than Scheimpflug imaging [11]. Scheimpflug imaging has advantages like non-contact, easy to perform and more sensitive to locate posterior capsular status to look for distention [11].…”

“…Other imaging modalities like anterior segment optical coherence tomography (AS-OCT) or ultrasound biomicroscopy (UBM) have also been described for the detection of CBDS, but less sensitive than Scheimpflug imaging [11]. Scheimpflug imaging has advantages like non-contact, easy to perform and more sensitive to locate posterior capsular status to look for distention [11]. Although skilled slit lamp examination can detect CBDS but recently Zhu showed asymptomatic CBDS almost 1 in every four patients in the same way ultra-late onset CBDS can be easily confused with posterior capsular opacification (PCO) because of asymptomatic in nature and can lead to misdiagnosis [2].…”

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

“…In our presenting patient, CBS had developed 13 years after the phacoemulsification surgery (the longest reported interval to the best of our knowledge), classifying it as type-3 CBS (1,3,(5)(6)(7)(8) .…”

How to Prevent Intra-Operatory Capsular Blockage? A New Surgical Approach: the Anti-Blockage Technique

“…Within the differential diagnosis we can find choroidal detachment, expulsive haemorrhage and misdirection syndrome. There have been different treatment options described before according to the clinical scenario [7][8][9]. In this manuscript we will describe a new surgical technique that we have called 'The Antiblockage Technique'.…”