Anterior chamber depth and refractive change in late postoperative capsular bag distension syndrome: a retrospective analysis.

Min Kyu Yang,Ji-Won Kwon,Young Keun Han,Won Ryang Wee,Demetrios Vavvas

doi:10.1371/journal.pone.0125895

Abstract

PurposeTo assess the characteristic findings and effects of laser capsulotomy in patients with late postoperative capsular bag distension syndrome (CBDS).MethodsTwenty patients diagnosed with late postoperative CBDS between July 2010 and August 2013 were retrospectively reviewed. Before and 1 week after capsulotomy, changes in the anterior chamber depth (ACD) were assessed using ultrasound biomicroscopy. Changes in the refractive status and uncorrected visual acuity (UCVA) were also measured 1 week and 1 month after capsulotomy. For patients who received bilateral cataract surgery, preoperative ACD and axial length measured by IOLMaster were compared between the two eyes.ResultsTwenty-two eyes from 20 patients who had undergone laser capsulotomy showed a mean UCVA improvement of 0.27 ± 0.24 logMAR (range, 0.00–0.90). ACD was increased by an average of +0.04 mm (95% confidence interval, +0.01 to +0.06 mm, p = 0.034), equivalent to predicted refractive change of +0.10 D. The discrepancy between actual (+1.33 D) and predicted refractive change after capsulotomy suggests that refractive change may not be generated from IOL displacement in late postoperative CBDS. Preoperative ACD was deeper in the eye with late postoperative CBDS in all bilaterally pseudophakic patients (mean, 3.68 mm vs. 3.44 mm in the fellow eye, p = 0.068).ConclusionsLate postoperative CBDS showed refractive changes that were resolved successfully after laser capsulotomy. The convex lens effects of opalescent material in the distended capsular bag may play a major role in myopic shift. A larger preoperative ACD is possibly associated with the development of late postoperative CBDS.

Highlights

Capsular bag distension syndrome (CBDS) is a rare complication of phacoemulsification with continuous curvilinear capsulorhexis (CCC) and posterior chamber in-the-bag intraocular lens (PC-IOL) implantation
anterior chamber depth (ACD) was increased by an average of +0.04 mm (95% confidence interval, +0.01 to +0.06 mm, p = 0.034), equivalent to predicted refractive change of +0.10 D
The discrepancy between actual (+1.33 D) and predicted refractive change after capsulotomy suggests that refractive change may not be generated from IOL displacement in late postoperative CBDS

Summary

Introduction

Capsular bag distension syndrome (CBDS) is a rare complication of phacoemulsification with continuous curvilinear capsulorhexis (CCC) and posterior chamber in-the-bag intraocular lens (PC-IOL) implantation. This condition is characterized by the accumulation of an opaque fluid within a closed chamber inside the capsular bag formed by the occluded anterior capsular opening created by the posterior chamber intraocular lens optic [1]. Postoperative CBDS is often accompanied by anterior displacement of the intraocular lens (IOL) optic, resulting in a shallow anterior chamber and myopic shift. Far, compared to other types of CBDS, late postoperative CBDS is considered to be less frequently associated with a shallow anterior chamber, forward IOL displacement, or myopic change [6,7]. Late postoperative CBDS is often not recognized until the development of posterior capsular opacification (PCO) in many cases and may be underestimated [8]

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