Propionibacterium acnes in capsular bag distension syndrome

Abstract

We report a case of capsular bag distension syndrome that developed 6 years after uneventful phacoemulsification with implantation of a foldable, single-piece acrylic intraocular lens (IOL) (AcrySof MA60BM). Slitlamp microscopy revealed a deep anterior chamber with no flare or cells. The posterior capsular bag was distended by a homogeneous milky substance between the back of the IOL and the capsular bag. Using a pars plana approach, a 23-gauge bimanual capsulotomy and anterior vitrectomy were performed. Microbiological analysis revealed Propionibacterium acnes in the material inside the capsular bag. The postoperative period was uneventful. Four weeks after surgery, visual acuity was restored and there were no signs of intraocular inflammation. The origin of late capsular bag distension is not fully understood; it may involve an infectious component with propionibacteria. A surgical approach and removal of the potentially infectious material can be considered as an alternative to neodymium:YAG capsulotomy.

Late capsular block syndrome presenting with posterior capsule opacification

“…In the literature, although Propionibacterium acnes was isolated in late CBS cases 40 to 72 months after cataract surgery by pars plana needle aspiration, there were no clinical signs of endophthalmitis in these cases. According to previous studies, 15,16 late postoperative CBS can be treated with Nd:YAG capsulotomy, although caution to prevent the risk for endophthalmitis should be taken. Similarly, we have not encountered endophthalmitis clinically.…”

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.…”

Outcome of Surgical Treatment in Late-Onset Capsular Block Syndrome

“…Several reports of late-onset CBS have also been verified to be related to Propionibacterium acnes ; hence, after posterior laser capsulotomy, P. acnes -associated endophthalmitis may occur [10, 11, 18, 19]. Moreover, posterior laser capsulotomy is difficult to perform because of opaque substance or severe expansion of the posterior capsule [12].…”

“…However, several severe complications, especially P. acnes -associated endophthalmitis, still exist [10, 11]. Sometimes, dense opaque substance and severe expansion of the posterior capsule make laser capsulotomy difficult [12].…”