Late-Onset Capsular Bag Distension Syndrome: A Report of Two Cases

Abstract

Capsular bag distension syndrome is a very rare complication of cataract surgery. Most cases occur after uneventful phacoemulsification with continuous curvilinear capsulorhexis and implantation of an intraocular lens in the capsular bag. The entity presents with reduction of visual acuity and myopic shift in the early-to-late postoperative period. Characteristic findings include the distension of the capsular bag due to the accumulation of milky material and the forward displacement of the intraocular lens. We present two cases with an unusually delayed presentation of 6 and 8 years respectively following phacoemulsification, and describe their successful management with Nd:YAG laser posterior capsulotomy.

Two cases of very late-onset capsular bag distension syndrome

“…Traditional treatment has relied on neodymium:yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy. 5 , 9 However, this risks posterior spread into the vitreous cavity of any proteins causing intra-ocular inflammation and any bacteria causing endophthalmitis. In particular, Propionibacterium acnes has been cultured in other cases of CBDS.…”

Sudden-Onset Painless Blurry Vision

“…Capsular bag distention syndrome can often be treated with Nd:YAG laser-assisted posterior capsulotomy, as this quick in-office procedure evacuates the turbid milieu from the capsular bag and resolves symptoms almost immediately. 5,7 When an infectious etiology, in particular Propionibacterium acnes, is suspected, use of pars plana vitrectomy is necessary to surgically remove the contents of the bag, along with possible IOL exchange and/or injection of intraocular antibiotics. 8,9 In this patient, there were no clinical findings of intraocular inflammation or capsular plaques to suggest infection.…”