Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy

Lin, Yuchen; Lin, Jingxia; Su, Zhipeng; Chen, Zhiqing; Yao, Ke

doi:10.1016/j.ajo.2019.02.035

Cited by 5 publications

(8 citation statements)

References 28 publications

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“…Thus, this type of patient showed a very mild myopic refraction shift after laser treatment. Lin et al 12 refraction change after the treatment of CBS. However, due to different study design and classification, we cannot compare our research group with that study group.…”

Section: Discussionmentioning

confidence: 99%

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Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics

Yang

Kao

Tsai

et al. 2022

Journal of the Chinese Medical Association

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Background: Late capsular blockage syndrome (CBS) is a rare phenomenon which is found after cataract surgery. The mechanism, anterior segment optical coherence tomography (OCT) presentation, and clinical characteristics are not well studied. Methods: We studied patients who developed late CBS in Taipei Veterans General Hospital from 2012 to 2019. Age, sex, systemic disease, ocular disease, interval between cataract surgery and CBS, axial length, type of intraocular lens implanted, grading of posterior capsular opacity, refraction, visual acuity, and anterior segment OCT findings were documented. Patients are categorized into two groups according to anterior segment OCT findings. All patients underwent Nd:YAG laser capsulotomy and were prescribed a low-dose topical steroid for 7 days. Postcapsulotomy refraction and visual acuity were recorded. All the clinical data were compared in the two groups. Results: This study included 18 eyes with late CBS. Patients’ median age was 80 (range, 54–92) years. The mean duration between cataract surgery and CBS diagnosis was 80.28 (range 15–136) months. According to anterior segment OCT findings, we subcategorized the patients into two groups: gravel appearance (n = 7) and milky (n = 11) appearance. After laser capsulotomy, mean visual acuity improved 0.18 ± 0.10 on the LogMAR. A significant myopic shift in refraction after laser capsulotomy was noted in the gravel appearance group compared to the milky appearance group (p = 0.027). No patient developed complications or needed further treatment for CBS during the median follow-up of 14.5 months (range 1–84 months). Conclusion: High-resolution anterior segment OCT is useful for analyzing patients with late CBS. Our study implies that the two types of CBS presentation indicate different causes of late CBS formation, as well as distinct clinical presentation and postlaser capsulotomy refractive outcome. In addition, YAG laser capsulotomy is a safe late CBS treatment modality.

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Section: Discussionmentioning

confidence: 99%

“…There were four classifications of PCO: minimal, mild, moderate, and severe. 12 Then, we chose anterior segment OCT (Optovue, USA) as a supplementary tool to evaluate the fluid trapped in the capsular space. The volume and density of fluid were evaluated with anterior segment OCT.…”

Section: Methodsmentioning

confidence: 99%

Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics

Yang

Kao

Tsai

et al. 2022

Journal of the Chinese Medical Association

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“…The accumulated fluid may lead to reduction of visual acuity, anterior displacement of the lens with or without associated refractive shift (most commonly myopic), and elevation of IOP . YAG capsulotomy may lead to a posterior distribution of the milky substance and resolves the causal mechanics …”

Section: Discussionmentioning

confidence: 99%

“…capsulotomy may lead to a posterior distribution of the milky substance and resolves the causal mechanics. 1,7 Elevation of IOP has been described in the context of CBDS. In the late-onset subtype, this is usually attributable to obvious flattening of the anterior chamber owing to the anterior displacement of the intraocular lens and subsequent angle obstruction.…”

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

“…8 In the case of capsular bag distension syndrome, YAG capsulotomy addresses the cause and offers a definitive treatment. 1,7 Glaucoma surgery could be a necessary therapeutic option, also later in the course. However, as an initial therapy, it would not target the issue of subjective visual deterioration and is more invasive.…”

Section: Jama Ophthalmology Clinical Challengementioning

confidence: 99%

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Elevated Intraocular Pressure With Visual Deterioration in a Pseudophakic Eye

Falb

Lindner

2022

JAMA Ophthalmol

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Case Series: Late Postoperative Capsular Block Syndrome Causing Reduced Vision Years After Uncomplicated Cataract Surgery

2019

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SIGNIFICANCE Late postoperative capsular block syndrome is a treatable complication presenting months to years after cataract surgery using continuous curvilinear anterior capsulorhexis and a posterior chamber intraocular lens implantation. Patients may present to optometric practices because of symptom onset significantly after the immediate post-operative period. PURPOSE The purpose of this study was to describe the defining clinical features, proposed pathophysiology, and treatment of late postoperative capsular block syndrome. Case 1 was a 68-year-old man who presented with a sudden onset of blurry vision in the right eye 2 years after uncomplicated cataract surgery. Clinical examination revealed turbid fluid distending the posterior lens capsule, a 2-D myopic shift, and an absence of intraocular inflammation. Laser posterior capsulotomy successfully released the trapped fluid and reversed the myopic shift without complication. Case 2 was a 67-year-old man who presented with a gradual onset of hazy vision in the right eye 7 years after uncomplicated cataract surgery. Cloudy fluid was observed to be filling the space between the intraocular lens and the posterior lens capsule, and the refractive error was stable. The fluid was liberated and visual function was restored with uncomplicated laser posterior capsulotomy. CONCLUSIONS Patients with late postoperative capsular block syndrome may present with blurry vision months to years after cataract surgery performed with continuous curvilinear capsulorhexis and posterior capsule intraocular lens implantation. The defining clinical sign is entrapment of turbid fluid between the intraocular lens and the posterior capsule that may result in reduced vision or refractive error shift. Late postoperative capsular block syndrome is distinguishable from other late complications of cataract surgery, including delayed endophthalmitis or phacoantigenic uveitis, by lack of concurrent robust ocular inflammation.

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Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy

Cited by 5 publications

References 28 publications

Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics

Late capsular blockage syndrome: Clinical and anterior segment optical coherence tomography characteristics

Elevated Intraocular Pressure With Visual Deterioration in a Pseudophakic Eye

Case Series: Late Postoperative Capsular Block Syndrome Causing Reduced Vision Years After Uncomplicated Cataract Surgery

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