Case Report: Role of Anterior Segment Optical Coherence Tomography in Late-onset Capsular Block Syndrome

Abstract

SIGNIFICANCE:We report the use of anterior segment optical coherence tomography (AS-OCT) as a valuable tool for capsular block syndrome diagnosis and follow-up. PURPOSE:The purposes of this study are to report a case of late-onset capsular block syndrome or lacteocrumenasia and to describe differential diagnosis with other more common phacoemulsification complications such as intraocular lens (IOL) or posterior capsule opacification. CASE REPORT:We report the case of a 56-year-old man with a clinical history of cataract surgery in his left eye. Five years after cataract surgery, he complained of blurred vision and was referred for IOL removal to our hospital. After careful slit-lamp examination, we found that the lens was clear, and opacity belonged to the accumulation of a whitish material in the capsular bag behind the lens. AS-OCT gave the definite diagnosis of capsular block syndrome. Intraocular lens removal had been wrongly indicated, and we treated our patient by YAG laser posterior capsulotomy. AS-OCT confirmed the absence of a further accumulated material, so no other interventions were needed. After treatment, best-corrected visual acuity improved from 0.48 to 0.1 logMAR.CONCLUSIONS: Capsular block syndrome is a rare late-onset complication of cataract surgery causing a deep visual acuity decay. A precise slit-lamp examination and AS-OCT, together, avoid misdiagnosis and unnecessary surgical treatment, which may be needed in case of IOL opacity or fibrotic-like lacteocrumenasia. AS-OCT also helps in determining the treatment outcome. Immediate best-corrected visual acuity improvement is reached after a successful intervention.

Anterior Segment Optical Coherence Tomography Findings in Capsular Block Syndrome with Improvement in Myopia following Neodymium-Yttrium Aluminum Garnet Laser Treatment

“…AS-OCT is a valuable tool for evaluating anatomical structures and qualitative factors in the cornea, anterior chamber, and even the optic media. The usefulness of AS-OCT in differentiating between IOL opacity and late-onset CBS has been highlighted [ 15 ]. We assessed the IOL depth before and after Nd-YAG laser treatment and observed a slight deepening of the IOL position, although the shift was less than 0.05 mm.…”

Late-Onset Capsular Block Syndrome with Pupillary Block Angle Closure after Cataract Surgery with Posterior Chamber Intraocular Lens Implantation: A Case Report

“…AS-OCT, as a noninvasive diagnostic technique, offers high resolution, low variability, and ease of use [ 5 ]. In cases of suspected CBS, AS-OCT can precisely assess the location and characteristics of the IOL and determine the depth of opacity, which is a crucial factor in distinguishing IOL opacity or posterior capsule opacity from CBS [ 11 ]. AS-OCT findings for CBS typically reveal a fibrotic anterior capsulotomy margin, the presence of a hyperreflective substance behind the IOL within an enlarged capsular bag with an intact posterior capsule, and a clear IOL [ 11 ].…”

“…In cases of suspected CBS, AS-OCT can precisely assess the location and characteristics of the IOL and determine the depth of opacity, which is a crucial factor in distinguishing IOL opacity or posterior capsule opacity from CBS [ 11 ]. AS-OCT findings for CBS typically reveal a fibrotic anterior capsulotomy margin, the presence of a hyperreflective substance behind the IOL within an enlarged capsular bag with an intact posterior capsule, and a clear IOL [ 11 ]. Accurate diagnosis of CBS and differentiation from IOL opacity or posterior capsule opacity are crucial for proper management, avoiding unnecessary invasive procedures [ 11 ].…”

“…AS-OCT findings for CBS typically reveal a fibrotic anterior capsulotomy margin, the presence of a hyperreflective substance behind the IOL within an enlarged capsular bag with an intact posterior capsule, and a clear IOL [ 11 ]. Accurate diagnosis of CBS and differentiation from IOL opacity or posterior capsule opacity are crucial for proper management, avoiding unnecessary invasive procedures [ 11 ]. Late CBS may resolve spontaneously owing to the contraction of fibrosis in the anterior capsule, creating an opening for fluid drainage [ 9 ].…”

Late-Onset Capsular Block Syndrome: A One Year Follow-up Case Report

“…AS-OCT is helpful in confirming the diagnosis. 9,10,11 We used AS-OCT and slit-lamp examination for diagnosis and to evaluate the amount of retrolental milky fluid and its complete resolution after treatment and to monitor the clinical course during the entire follow-up. Treatment with Nd:YAG laser posterior capsulotomy allowing the rapid evacuation of liquid toward the vitreous chamber was sufficient to provide a complete, quick and lasting resolution of the CBS.…”