Capsulorhexis-related lacteocrumenasia

Abstract

Three patients who presented with a milky fluid in the space between the posterior surface of implanted intraocular lens (IOL) and the anterior surface of the distended posterior capsular bag are described. The patients were followed and were noted to have changes in their benign course after several years. The occurrence of this milky-fluid-filled capsular bag is extremely uncommon and is difficult to perceive if the observer is not looking for it.

Capsular block syndrome presenting with a hyperopic shift

“…Indeed, late CBS has been described as lacteocrumenasia or liquefied aftercataract. [7][8][9] These 2 factors, ie, insignificant anterior IOL displacement and concave lens effect, can explain the hyperopic shift. A reduced myopic shift was also described by Theng et al 4 in the 2 late postoperative cases (case 7, 2 years postoperative, with a refraction of plano; case 8, 5 months postoperative, with a refraction of -0.75 diopter).…”

Shifting crystalline pseudohypopyon secondary to lens absorption with spontaneous openings in the anterior lens capsule

“…5 Rarely, postoperative lacteocrumenasia may be seen as milky-white, fluid-filled capsular bag deposits that are characterized by the accumulation of liquefied substances in a closed chamber between the posterior surface of an implanted IOL and the posterior capsule on occlusion of the anterior capsulorhexis opening. 6,7 In the present case, the pseudohypopyon was characterized by quick movement (within seconds) on positional changes. A true hypopyon is slow moving (within a few minutes) if the sediments contain low fibrin levels (ie, ocular Behçet disease); it is completely immobile if the sediments contain high fibrin concentrations (ie, HLA-B27-related uveitis).…”

Treatment of late-onset capsular distension syndrome with a neodymium:YAG laser peripheral iridotomy and anterior capsulotomy

“…Many treatment options exist, including the use of pars plana vitrectomy and surgical or Nd:YAG laser capsulotomy in cases with a milky fluid. 1,2,4,6,7 This aggressive approach has been propagated by reports of Propionibacterium acnes in the fluid, 5 although in that case, as in the one we report, there was no anterior or vitreous chamber inflammation to suggest endophthalmitis.…”

“…When this process occurs in the late postoperative period, the captured fluid may be opacified and resemble the consistency of milk. [5][6][7][8] Several techniques to treat capsular distension syndrome have been described. The neodymium:YAG (Nd:YAG) laser can be used to create an anterior or posterior capsulotomy to provide an exit for the accumulated fluid.…”