Two cases of very late-onset capsular bag distension syndrome

Abstract

PurposeWe present two cases of late-onset capsular bag distension syndrome (CBDS).ObservationsTwo female patients were referred with decreased visual acuity and blurred vision. They had both undergone uncomplicated phacoemulsification and intraocular lens implantation into the capsular bag, seven and 13 years prior.Slit-lamp biomicroscopy and anterior segment optical coherence tomography demonstrated milky fluid between the intraocular lens and posterior capsules, consistent with late-onset capsular bag distension syndrome. A 25-gauge pars plana vitrectomy surgery was performed on each patient.This turbid retrolental fluid was successfully aspirated with posterior capsulotomy using 25-gauge pars plana vitrectomy surgery.Conclusions and importanceLate-onset capsular bag distension syndrome may occur up to 13 years following cataract surgery; the longest reported duration of onset. Anterior segment optical coherence tomography is useful in aiding diagnosis. Management with vitrectomy surgery has the advantages of complete clearance of the turbid fluid and microbial and pathological testing.

Unusual Late Presentation of Capsular Bag Distension Syndrome Associated With Propionibacterium acnes Endophthalmitis

“…And second, there was a high suspicion of associated P. acnes; therefore, violation of the posterior capsule by Nd:YAG laser might cause further dissemination of the infection into the vitreous cavity [ 5 ]. Raina et al and Galvin et al managed their late-onset CBDS cases by PPV with posterior capsulotomy, similar to our surgical approach, and all cases showed excellent outcomes with complete resolution [ 9 , 10 ]. This emphasizes the good prognosis of this condition with the surgical management by PPV with posterior capsulotomy.…”

“…And third, having the associated symptoms of recurrent mild pain, photophobia, and redness with the dramatic resolution of these symptoms after the surgical management. To the best of the author's knowledge, up to date, there is only one reported case that described CBDS development after 14 years [ 4 ], and only two described it after 13 years (as in our patient) [ 8 , 9 ]. Upon careful examination of the anterior segment with maximal dilation, it was noted that the capsulorhexis of the OS was small (4.7 mm) compared to the OD (5.5 mm), which explains the unilateral involvement in our case.…”

Late-onset capsular bag distention syndrome resistant to laser treatment: a case report

“…Several risk factors for CBDS have been reported in the literature. Residual cortical material is a well-known risk factor, resulting in a milky fluid due to the secretion of alpha crystalline proteins [ 4 ]. Other factors include retainment of the ophthalmic viscoelastic device possibly by an osmotic gradient mechanism [ 2 , 3 , 5 ], longer axial length [ 1 ] and smaller continuous curvilinear capsulorhexis or larger IOL design because of which the IOL and anterior capsule overlap area is larger, resulting in, the occlusion of the intra-capsular fluid egression pathway [ 6 ].…”

“…Pars plana vitrectomy and posterior capsulotomy for CBDS have not been adequately studied. As in our case, surgical intervention by pars plana vitrectomy and posterior capsulotomy has several advantages over other approaches, including a lower risk of P. acne endophthalmitis or inflammation, which might be aggravated by Nd:YAG or anterior approach capsulotomy [ 4 ], and the prevention of a possible rise in the intraocular pressure caused by collagen in the milky fluid that might clog the trabecular meshwork [ 12 ].…”

“…However, apart from the known possible complications of pars plana vitrectomy, it is also considered to be more invasive and costly [ 4 ].…”