Outcome of Surgical Treatment in Late-Onset Capsular Block Syndrome.

Yang Huang,Zhaohui Li,Zi Ye,Hang Li

doi:10.1155/2017/1847179

Abstract

Purpose To further investigate the pathogenesis of late-onset capsular block syndrome (CBS) and to evaluate the safety of surgical treatment. Methods Seven patients diagnosed with late-onset CBS were retrospectively analyzed. Anterior chamber depth (ACD), intraocular pressure (IOP), refractive diopter, and best-corrected visual acuity (BCVA) before and after surgery were recorded. The opaque substance was tested with Western blot, and a flow cytometer multiple array assay system was utilized to evaluate the levels of inflammatory cytokines from opaque substance and aqueous humor, respectively. Results Patients who had undergone surgical treatment showed a significant BCVA and spherical equivalent refractive error improvement (P = 0.002, P = 0.021, resp.). Nevertheless, ACD and IOP before and after surgery were in normal range with no difference (P = 0.165, P = 0.749, resp.). αB-crystallin and βB-crystallin were detected in all opaque substances. Tumor necrosis factor-alpha (TNF-α) and interlukin-1β (IL-1β) levels in opaque substance were significantly higher than those in aqueous humor (P = 0.038, P = 0.007, resp.), while IL-2 and IL-6 were not detected in any samples. Conclusions Opaque substance is derived from human lens epithelial cells. Inflammatory cytokines may be involved in the pathogenesis of late-onset CBS. In addition, surgical treatment is an effective approach. This trial is registered with ChiCTR-IOR-17011287.

Highlights

Capsular block syndrome (CBS) is a rare complication related to phacoemulsification, which is described as the accumulation of opaque substance between the posterior chamber intraocular lens (PC-IOL) and posterior capsule, and was first described by Davison [1, 2]
Nd:YAG laser treatment, including anterior and posterior laser capsulotomy, has been recommended as the major approach to cure late-onset CBS for its microinvasion and convenience [9, 14], while more and more authors are worried about the potential complications after posterior laser capsulotomy, such as vitreous floaters, cystoid macular edema, and retinal detachment [15,16,17]
Several reports of late-onset CBS have been verified to be related to Propionibacterium acnes; after posterior laser capsulotomy, P. acnes-associated endophthalmitis may occur [10, 11, 18, 19]

Summary

Introduction

Capsular block syndrome (CBS) is a rare complication related to phacoemulsification, which is described as the accumulation of opaque substance between the posterior chamber intraocular lens (PC-IOL) and posterior capsule, and was first described by Davison [1, 2]. Based on the time of onset, Miyake et al [3] classified CBS as intraoperative (caused by high irrigation pressure during hydrodissection maneuvers), early postoperative (due to osmotic gradient accumulation), and late-onset (originated from residual lens epithelial cells). Increased aqueous flare intensity and cells were observed in more than half of these patients [8], while the relation of inflammatory cytokines levels from opaque substance and aqueous humor in late-onset CBS has yet to be recognized

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