Sudden-Onset Painless Blurry Vision

Abstract

A man in his late 30s with a history of proliferative diabetic retinopathy presented for evaluation of sudden-onset painless blurry vision of the right eye. His ocular history included nonclearing vitreous hemorrhage in the right eye requiring pars plana vitrectomy, panretinal photocoagulation, multiple treatments with intravitreous bevacizumab, and cataract extraction with placement of an intraocular lens (IOL) into the capsular bag approximately 4 years ago. At his routine follow-up visit 2 weeks prior, the proliferative diabetic retinopathy was quiescent, and his Snellen visual acuity was 20/20 OD with manifest refraction of −1.50 + 0.25 × 180. Examination of the anterior segment at that time was unremarkable.At his current visit, visual acuity with the previous correction had been reduced to 20/150. Repeated manifest refraction of the right eye was −4.00 + 1.50 × 166, resulting in a visual acuity of 20/25. Intraocular pressure of the right eye was 10 mm Hg by Goldmann applanation tonometry. Evaluation of the posterior segment, including dilated fundus examination and optical coherence tomography (OCT) of the macula, showed stability compared with previous results. Imaging of the anterior segment with OCT is shown in Figure 1. The anterior chamber did not appear shallow, and there was no cell or flare. Diagnosis Capsular bag distention syndrome What to Do Next B. Perform posterior capsulotomy with Nd:YAG laser DiscussionThe key to diagnosis is recognizing hyperdistention of the capsular bag with a turbid milieu posterior to the IOL (Figure 1) along with a myop-