Intraoperative Capsular Block Syndrome: A Case Report

Abstract

Purpose: To report a case of intraoperative capsular block syndrome (ICBS), an unusual complication during cataract surgery. Methods: Observational case report. Results: This 76-year-old man had senile cataracts and received phacoemulsification of the right eye. After temporal clear corneal incision, 0.4 ml of a viscoelastic agent was injected into the anterior chamber. Continuous curvilinear capsulorhexis (CCC) was performed with a bent 27-gauge needle and a capsular forceps. The diameter of the CCC was 3 mm without radial tear. After hydrodissection with 0.3 ml of balanced salt solution (BSS) at 6 o’clock, dim red reflex of the lens and shallow anterior chamber were found. Following additional 0.2 ml of BSS injected at 12 o'clock, the anterior chamber became deeper and the whole nucleus suddenly tilted into vitreous cavity with posterior capsular rupture. Therefore, ICBS was impressed. The nucleus was delivered with a lens loop after viscoelastics injection into the anterior and posterior side of the nucleus. The patient underwent anterior vitrectomy to remove the prolapsed vitreous and residual cortex. On the fellow eye of this patient, the operation was altered at two points to prevent ICBS: (1) a larger CCC up to 5.5 mm in diameter was created and (2) hydrodissection was carried out after nucleus fracture using a phaco-tip. Conclusion: ICBS resulted from blockage of fluid (BSS) in the capsule by the lens nucleus owing to small CCC and some risk factors. A combination of hydrodissection after nucleus fracture and larger CCC can solve this problem.