Clinical and histopathological findings in the dead bag syndrome

Abstract

To describe the findings of a recently described syndrome, the dead bag syndrome, in which the capsular bag appears to be clear many years postoperatively, becoming diaphanous and floppy and unable to support the intraocular lens (IOL) within it.

Age-related appearance of lamellar structures in lens capsule of cataractous eyes and its pathological significance

“…In addition, it has been suggested that lens or in-the-bag IOL dislocation may occur in conjunction with zonular lamella detachment. 14,25,28,29 It is important to elucidate the mechanisms underlying structural maintenance of the lens capsule.…”

“…In addition, it has been suggested that lens or in-the-bag IOL dislocation may occur in conjunction with zonular lamella detachment. 14,25,28,29 It is important to elucidate the mechanisms underlying structural maintenance of the lens capsule.

WHAT WAS KNOWN

Studies on mechanical properties have shown that the lens capsule becomes more fragile with aging.In a recent study, true exfoliation of the lens capsule was more common in older patients (70s and older), suggesting that this is due to age-related structural changes in the lens capsule.Only few studies have examined age-related changes in the lens capsule ultrastructure.

WHAT THIS PAPER ADDS

The lens capsule has a uniform internal structure in younger patients, whereas it has lamellar structures more frequently in older patients.The lamellar structures seen in the lens capsule of older patients are quite similar to those seen in true exfoliation, and the latent structural changes associated with aging of the lens capsule can cause true exfoliation.

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The dead bag syndrome

“…Histopathological findings of the dead bag syndrome capsules were compared with those of capsules from 40 cases of in-the-bag IOL dislocation, including 26 cases with evident pseudoexfoliation material. 2,3 LECs and Soemmerring's ring formation were observed in all cases; capsulorhexis phimosis was also a relatively common finding, while capsular splitting/delamination was only found in 1 specimen. A review of the literature indicates there is also capsular splitting/delamination in true exfoliation syndrome.…”

“…We recently had this opportunity, through collaboration with Masket and 3 other surgeons recognizing similar cases, Drs. Jason Jones, Nicole Fram, and Gregory Ogawa, culminating in the first peerreviewed study, to our knowledge, on the dead bag syndrome, published in the February issue by Culp et al 2 A total of 10 cases were included, with a mean time between implantation and explantation (when performed) of 10.6 ± 5.6 years. It is noteworthy that no signs of zonular instability were reported during the implantation surgeries, which were all uneventful.…”

“…The explanted IOLs were either 3-piece silicone or single-piece hydrophobic acrylic IOLs and were unremarkable under light microscopy aside from mild pigmentary dispersion on their surfaces. 2…”