Prevention of capsular block syndrome

Abstract

In their report of capsular block syndrome (CBS) associated with secondary angle-closure glaucoma,1 Liu and Chou successfully managed the case with a neodymium:YAG laser capsulotomy. However, the best treatment of CBS is prevention by complete removal of the viscoelastic material after intraocular lens (IOL) insertion and intraoperative peripheral anterior capsulotomy (IPAC), as suggested by Yepez and coauthors,2 who performed IPAC using the 23-gauge tip of a wet-field hemostatic eraser. We suggest a simple and safe method to perform IPAC to prevent CBS. It is performed after inserting the IOL but before aspirating the viscoelastic material. The tip of the irrigation/aspiration (I/A) probe is inserted beneath the margin of the anterior capsulorhexis at the site of the desired IPAC, beyond the edge of the IOL, with the port facing anteriorly. A 26-gauge bent capsulotomy needle is inserted through the side port and placed with the tip facing posteriorly over the site of the proposed IPAC, so the needle and port of the I/A tip are perpendicular to each other and sandwich the anterior capsule. A puncture is made in the anterior capsule at this site by dipping the tip of the needle posteriorly into the opening of the aspiration port in the I/A tip. The I/A tip helps to stabilize the anterior capsule and prevents accidental puncture of the posterior capsule. As this opening may close over time, more than 1 IPAC is desirable. Further closure of the IPAC can be prevented by tearing the IPAC flap into a semicapsulorhexis with a forceps. If pupillary dilation is inadequate, these maneuvers can be facilitated by putting an iris hook in the desired quadrant. Complete removal of the viscoelastic substance from the capsular bag anterior and posterior to the IOL should be performed at the end of the procedure. Harinder Sethi MD Tanuj Dada MD aNew Delhi, India