Late-onset capsular bag distension syndrome following antihistamine administration

Abstract

A 51-year-old woman presented with acute myopic shift 3 years after uneventful cataract extraction in both eyes; recent medical history was remarkable for administration of intravenous meclizine 2 weeks prior to presentation. Examination of each eye revealed anterior chamber crowding and a posterior chamber intraocular lens (IOL) with distension of the capsular bag; clear fluid with a green hue was present between the IOL and the posterior capsule. We postulate a mechanism for the development of late-onset capsular bag distension syndrome. To our knowledge, no medication-induced incidences have been reported in the literature. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2014; 2:58-60 Q 2014 ASCRS and ESCRSCapsular block is a rare complication of cataract surgery with posterior chamber intraocular lens (PC IOL) implantation following a continuous curvilinear capsulorhexis (CCC). Capsular block is traditionally classified by its time of onset: intraoperative, early postoperative, or late postoperative. 1 The mechanism of late postoperative capsular block involves the accumulation of particulate matter posterior to the IOL, which draws aqueous humor posterior to the IOL via osmosis. 2 We describe a unique case of late-onset capsular block secondary to a systemic antihistamine and hypothesize a mechanism for the development of capsular block. CASE REPORTA 51-year-old Asian woman presented complaining of acutely decreased vision at distance and improved vision at near. The ocular history was significant for uneventful cataract extraction with bilateral implantation of a 1-piece acrylic PC IOL 3 years previously. On examination 3 months before presentation, the uncorrected distance visual acuity was 20/20 in both eyes; dilated fundoscopy was unremarkable, with monofocal acrylic 1-piece IOLs positioned in the capsular bag; and there was no anterior capsule fibrosis or fluid accumulation behind the IOLs. The recent medical history was remarkable for vertigo, for which the patient had been admitted to the hospital and administered intravenous meclizine 2 weeks previously.On examination, the corrected distance visual acuity (CDVA) was 20/20 with a manifest refraction of À1.50 À1.00 Â 165 in the right eye and 20/20 with a manifest refraction of À1.50 À0.25 Â 15 in the left eye. Slitlamp examination was remarkable for anterior chamber crowding in both eyes. Gonioscopy revealed a 360-degree grade III ciliary body in both eyes with mild plateau iris configuration. Intraocular pressure was 15 mm Hg in the right eye and 17 mm Hg in the left eye. Dilated examination was remarkable for a PC IOL in each eye, with appreciable distension of the capsular bags and clear fluid with a green hue posterior to both IOLs (Figure 1).Humphrey visual field testing was within normal limits in both eyes, as was optical coherence tomography (OCT) of the macula. Optical coherence tomography of the angle showed slight anterior displacement of the iris in both e...