Sir,
Capsular block syndrome (CBS) is a rare complication that occurs with posterior chamber in the bag intraocular lens (IOL) placement, with continuous curvilinear capsulorhexis.1 It classically presents with forward displacement of IOL and associated myopic shift,2, 3 and usually occurs in the intra- or early postoperative period.4 We report a case of late CBS secondary to the liquefied after-cataract without the lens displacement or change in the refractive status.
Case report
An 85-year-old lady presented to the eye clinic with a history of recent deterioration of vision in her left eye. She had undergone phacoemulsification 5 years ago. The operation was uneventful with continuous curvilinear capsulorhexis of moderate size and one-piece posterior chamber lens implant. She was not at high risk for CBS. The postoperative recovery was good with the best-corrected visual acuity being 6/6.
On examination best-corrected visual acuity in the affected eye was 6/9. Slit-lamp biomicroscopy showed thick and taut anterior capsule adhered to the lens at the margin of capsulorhexis. The capsular bag was distended and bulged back into the vitreous with entrapped milky white fluid of liquefied after-cataract between the posterior capsule and the lens. The lens was in situ without any shallowing of anterior chamber (Figure 1a). The vitreous had syneristic changes. Fundus examination was unremarkable.
(a) Before YAG laser (b) after YAG laser.
A posterior Nd:YAG laser capsulotomy was carried out. The fluid interface and distorted posterior capsule disappeared immediately after the procedure (Figure 1b), with restoration of visual acuity to 6/6 unaided a week later. The AC depth measured on IOL master before and after the laser treatment was the same and there was no difference in the refractive status of the eye compared to her early postoperative finding.
Comment
Late postoperative CBS even though rare is well documented in the literature.5, 6 The distension of posterior capsule, anterior chamber shallowing, unexpected myopic shift, and persistent uveitis are some of the presenting features. In our case, in contrast to the commonly reported earlier types, the structural changes in the anterior capsule with rigid fibrosis had prevented the displacement of IOL. Hence, there was no change in the refractive status of the eye.
References
Chang D-F . Etiology of capsular block syndrome. J Cataract Refract Surg 2001; 27(10): 1531.
Sorenson AL, Holladay JT, Kim T, Kendall CJ, Carlson AN . Ultrasonographic measurement of induced myopia associated with capsular bag distension syndrome. Ophthalmology 2000; 107(5): 902–908.
Baikoff G, Rozot P, Lutun E, Wei J . Assessment of capsular block syndrome with anterior segment optical coherence tomography. J Cataract Refract Surg 2004; 30(11): 2448–2450.
Miyake K, Ota I, Ichihashi S, Miyake S, Tanaka Y, Terasaki H . New classification of capsular block syndrome. J Cataract Refract Surg 1998; 24(9): 1230–1234.
Cheung D, James N . Late onset capsular block syndrome: an occult cause of decreased vision in a 63-year-old pseudophakic Asian woman. Eye 2001; 15(Part 1): 107–108.
Wang J-C, Cruz Joseph . Late postoperative capsular block syndrome: entrapment of liquefied after-cataract by capsular bend. Cataract Refract Surg 2005; 31(3): 630–632.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patil, S., Azarbod, P. & Toufeeq, A. Late-onset capsular block syndrome without lens displacement. Eye 21, 113–114 (2007). https://doi.org/10.1038/sj.eye.6702419
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.eye.6702419
