Bag Distension Research Articles

Capsular bag distension syndrome with sulcus IOL acting as a seal

Capsular bag distension syndrome (CBDS) is a rare complication following cataract surgery with posterior chamber intraocular lens (IOL) implantation. We describe the case of a 68-year-old female who developed early-onset CBDS of her left eye after manual small-incision cataract surgery with implantation of posterior chamber IOL in the sulcus (Excel PMMA IOL (polymethyl methacrylate), Manufactured by Excel Optics (P) Limited, Chennai). The patient had an uneventful cataract surgery performed by a resident in training. Her immediate postoperative uncorrected vision was 20/40, but it decreased to finger counting 1 m on postoperative day 7, for which she presented back to hospital. Slit-lamp examination revealed a quiet anterior chamber without any cells–flare with IOL in the sulcus with a relatively smaller capsulorhexis of about 5 mm, and IOL optic was covering the capsulorhexis in a symmetric fashion, thus causing a block. Distension of capsular bag was further confirmed by Anterion anterior segment optical coherence tomography (Heidelberg Engineering Technology, Germany), which showed a confined hyperechogenic fluid trapped between the IOL and the posterior capsule. She was diagnosed with CBDS secondary to retention of turbid fluid. Phased treatment was done; neodymium-doped yttrium aluminum garnet capsulotomy was tried in the first attempt, but failed as the posterior capsule was far too behind. This was followed by anterior chamber wash with redialing of the lens in the bag, which thereby improved vision to 20/20 (best corrected visual acuity) at 1-week postoperatively. Even with IOL in the sulcus, the postoperative CBDS may rarely happen at any point of time with a small capsulorrhexis and an intumescent mature cataract. Immense cortex wash should always be kept in mind in such a case, as the liquefied cortex is sometimes stuck at the equator and a little more duration of irrigation is required in such scenarios. Hence, complete clearance of turbid fluid of intumescent mature cataract variety also holds due importance similar to the need of removing viscoelastic substance to prevent CBDS.

Multimodal imaging of capsular bag distension syndrome

Multimodal imaging of capsular bag distension syndrome

Late-onset capsular bag distension syndrome drainage captured on SSOCT

Late-onset capsular bag distension syndrome drainage captured on SSOCT

Acute Effects of Neodymium-Doped Yttrium Aluminum Garnet Laser Capsulotomy on Anterior Segment Parameters in Capsular Bag Distension Syndrome.

Background: Capsular bag distension syndrome (CBDS) can be effectively treated using either Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy or surgery. Assessing anterior segment, particularly immediately after Nd:YAG laser capsulotomy, could provide clinically relevant information on ocular dynamics, refractive changes, and complication mechanisms, especially in late postoperative CBDS. Objective: To explore the acute effects of Nd:YAG laser posterior capsulotomy on anterior segment parameters in late postoperative CBDS. Methods and results: In this study, 20 patients underwent Nd:YAG laser posterior capsulotomy after cycloplegia, during which milky-white fluid material migrated into the anterior vitreous. Anterior segment parameters were assessed before and immediately after laser using Scheimpflug-Placido topographer. The main outcome measures were differences in best-corrected visual acuity (BCVA), aqueous depth (AqD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume (CV), and central corneal thickness (CCT) at the baseline versus at immediately after laser. The mean age and duration since surgery for CBDS presentation were 70.25 ± 6.21 and 6.15 ± 1.31 years, respectively. The AqD, ACV, ICA, and spherical equivalent increased significantly compared with baseline (4.18 vs. 4.02 mm, p = 0.001; 177 vs. 173.55 mm3, p = 0.004; 51.15° vs. 50.15°, p = 0.023; -1.00 vs. -2.00 D, p = 0.003, respectively). These changes were also associated with significantly improved BCVA an hour after capsulotomy [0.2 (0.05-0.2)] relative to baseline [0.3 (0.2-0.5)], (p = 0.001). CCT and CV decreased nonsignificantly; horizontal AC diameter and K1 and K2 increased nonsignificantly (p > 0.05). Conclusions: Nd:YAG laser posterior capsulotomy appears to be an effective CBDS treatment for acutely improving vision, potentially due to immediate refractive changes caused by altered anterior segment parameters.

Capsular Bag Distension Syndrome after Uneventful DMEK for Fuchs Corneal Endothelial Dystrophy

Capsular bag distension syndrome (CBDS), or capsular block syndrome, is a rare complication (< 1%) following cataract surgery with continuous curvilinear capsulorhexis, phacoemulsification, and intraocular lens (IOL) implantation in the capsular bag. It is characterized by accumulation of cloudy fluid between the IOL and the posterior lens capsule. The signs or symptoms can develop in the early or late postoperative period and have been reported even 20 years after cataract surgery [1]. The entrapped fluid leads to poor visual acuity. A myopic refractive shift in 80% of patients and hyperopic shift in 20% of patients have been reported [2]. In some cases, elevation of intraocular pressure (IOP) has been described.

Scheimpflug Imaging of Late-onset Capsular Bag Distention Syndrome Treated with Nd: YAG Laser: A Case Report

Aims: To report a case of very late-onset capsular bag distention syndrome (CBDS) 8 years after uncomplicated cataract surgery treated with Neodymium: Yag (Nd: Yag) laser posterior capsulotomy.&#x0D; Presentation of the Case: A 76-year-old female patient without any systemic or ocular disorders, presented with progressive blurry vision in her right eye (RE) over the last 1 year. Best-corrected visual acuity (BCVA) was 6/9 in the right eye and 6/6 in the left eye. Manifest refraction revealed a 0.5 diopters myopic shift in her RE compared to her last ocular examination 2 years ago. Scheimpflug photograpgy and slit-lamp examination were utilized to make the diagnosis of CBDS, which was successfully treated with Nd: Yag laser posterior capsulotomy. At day 1 post-capsulotomy the BCVA of her RE improved to 6/6 with a 0.5 diopters hyperopic shift which was consistent with a 0.13 mm post-capsulotomy increase in the anterior chamber depth, as documented by the Scheimpflug images.&#x0D; Discussion and Conclusion: Late-onset CBDS can manifest after a considerable time period following cataract surgery and Scheimpflug imaging can be a useful aid for a precise diagnosis and documentation of the treatment.

Multimodality imaging technique for capsular bag distension syndrome

Multimodality imaging technique for capsular bag distension syndrome

Capsular bag distension syndrome after uneventful DMEK for Fuchs corneal endothelial dystrophy

AbstractPurpose: Capsular bag distension syndrome or capsular block syndrome is a rare complication of cataract surgery characterized by accumulation of fluid between the intraocular lens and the posterior lens capsule, leading to visual deterioration. A small continuous curvilinear capsulorhexis, residual cortical lens material, as well as residual viscoelastic material behind the intraocular lens are associated with increased risk of fluid entrapment. Capsular bag syndrome usually occurs in the early postoperative period, but it has also been described as late as 14 years after cataract surgery. Nd‐YAG laser posterior capsulotomy is the treatment of choice in most cases, facilitating the drainage of the fluid in the vitreous cavity. Late‐onset capsular block syndrome is often associated with Propionibacterium acnes, requiring surgical management.Methods: Hereby we report a case of a 72‐year‐old female patient with Fuchs corneal endothelial dystrophy, who developed a capsular block syndrome after an uneventful endothelial keratoplasty (DMEK).Results: In the early postoperative period after the DMEK, we observed the development of capsular block syndrome OS. The patient was subjected to bilateral cataract surgery 6 years ago. After intensive follow‐up examination for excluding Propionibacterium acnes‐related endophthalmitis, we proceeded with Nd‐YAG capsulotomy, which resulted in drainage of the fluid in the vitreous cavity and immediate visual recovery.Conclusions: To our knowledge this is the first report of capsular bag syndrome after DMEK and therefore anterior segment surgeons should be aware of this rare complication.

Lacteocrumenasia

Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery characterized by collection of turbid fluid between the posterior surface of the intraocular lens (IOL) and the posterior capsule. Here, we report a case of CBDS presenting 7 years after uneventful cataract surgery. Patient presented with blurring of vision in the right eye and his best corrected visual acuity (BCVA) was 6/9 N6. Slit lamp examination showed collection of turbid fluid between IOL and posterior capsule, and the opaque fibrosed capsulorhexis margin was adherent to the optic of IOL which was well placed within the bag. Patient underwent neodymium yttrium aluminium garnet (ND-YAG) laser posterior capsulotomy to release the fluid into the vitreous cavity. 6 weeks after the procedure his BCVA improved to 6/6 N6.

Capsular bag distention syndrome in a child

Capsular bag distention syndrome in a child

Capsular Bag Distention Syndrome after 9 years of Cataract Surgery

A 65-year-old male presented with complaints of foggy vision and glare in the right eye since 2 months. He had an uneventful cataract surgery in the right eye 9 years back and in the left eye 4 years back following which he had gained a visual acuity of 6/9 in both eyes. On examination his distance visual acuity was 6/12 in the right eye. Slit-lamp examination shows a peripheral soemmering ring and on careful inspection of the right eye posterior-chamber intraocular lens (PCIOL), a yellow-whitish turbid fluid collection was observed (Figure A).

Long-term anorectal function in rectal cancer patients treated with chemoradiotherapy and endorectal brachytherapy.

The aim was to study anorectal function in long-term survivors after combined, curatively intended, chemoradiotherapy and endorectal brachytherapy for low rectal cancer. This was a case-control design. We compared anorectal function by anal manometry, anal functional lumen imaging probe (EndoFLIP) and rectal bag distension in rectal cancer patients (RCPs) and healthy, normal subjects (NSs). Symptoms were assessed by the low anterior resection syndrome (LARS) and Wexner faecal incontinence scores. Thirteen RCPs (12 men, median age 68years, range 52-92) after 60Gy radiotherapy, 5Gy endorectal brachytherapy and oral tegafur-uracil with complete clinical response (median time since treatment 2.8years, range 2.2-5.6) were compared to 15 NSs (14 men, median age 64years, range 47-75). RCPs had lower than normal anal resting pressure, 38.6 mmHg (range 8.8-67.7) versus 58.8mmHg (25.7-105.2) (P<0.003), and squeeze pressure, 117 mmHg (55.2-203) versus 188mmHg (103-248) (P<0.01). Squeeze-induced pressure increase recorded by EndoFLIP was also lower in RCPs (q>7.56, P<0.001) as was the anal canal resistance to increasing distension (q=3.13, P<0.05). No differences in median rectal volume at first sensation (72 [22-158] vs. 82 [36-190] ml, P=0.4) or at urge to defaecate (107 [42-227] vs. 132 [59-334] ml, P=0.2) were found. However, maximum tolerable rectal volume was lower in RCPs (145 [59-319] vs. 222 [106-447] ml, P<0.02). The median (range) low anterior resection syndrome score was 27 (0-39) for RCPs and 7 (0-23) for NSs (P<0.001), while the Wexner score was 0 (0-5) versus 0 (0-4) (P=0.56). Radiotherapy combined with endorectal brachytherapy for rectal cancer causes long-term anorectal symptoms, impaired anal sphincter function and reduced rectal capacity.

Capsular Bag Distension Syndrome Following Phacoemulsification with Implantation of Intraocular Lens

Capsular bag distension syndrome is a rare complication following phacoemulsification with posterior chamber intraocular lens implantation. We describe the case of a middle-age male, who developed early onset capsular bag distension syndrome of the right eye after phacoemulsification with implantation of plate haptic posterior chamber intraocular lens (Zeiss CT ASPHINA 509MP). There was persistent poor vision during follow up at 1 week and 5 weeks post-surgery with a myopic shift of 2.5 diopters sphere (DS). The intraocular pressure was only elevated at 2 hours post-operative and was normal during the subsequent followup. Distension of capsular bag was confirmed with the IOP Master 700 which showed abnormal separation of posterior capsule from the intraocular lens. He was diagnosed with capsular bag distension syndrome secondary to retention of viscoelastic. Right eye removal of retained viscoelastic was performed and the capsular bag distension syndrome resolved successfully with best corrected visual acuity at 6/6. Hence, complete clearance of viscoelastic during phacoemulsification with plate haptic intraocular lens is important in order to prevent capsular bag distension syndrome.

Pure phaco: phacoemulsification without ophthalmic viscosurgical devices

The ophthalmic viscosurgical device (OVD) is an essential part of modern phacoemulsification surgery. Many times, OVDs are blamed for intraocular pressure spikes, toxic anterior segment syndrome, and capsular bag distension syndrome. To avoid these complications, we developed a technique in which phacoemulsification can be done without using OVDs. The irrigating cannula, on a continuous irrigation mode, was introduced through a side port, and capsulorhexis and incision construction were performed under an irrigating balanced salt solution. No hydroprocedure was performed. Phacoemulsification was done by chopping technique. At the end of the procedure, the intraocular lens was implanted by wound assistance technique under a continuous irrigation mode.

Delayed capsular bag distension syndrome.

Delayed capsular bag distension syndrome.

Implications of rectal preconditioning for interpretation of sensory-motor data

Testing of biomechanical properties of intestine requires the tissue to be preconditioned by applying cyclic loading to obtain repeatable mechanical data. However, little is known about the mechanosensory properties during intestinal preconditioning. We aimed to study the relationship between mechanical preconditioning of the human rectum and sensory response. Three fast rectal bag distensions to the pain threshold were done in seven healthy females. A visual analog scale (VAS) was used for sensory assessment. At each distension, we determined (1) time, bag cross-sectional area (CSA), radius (r), r/r0, pressure and tension to reach VAS = 1, 3 and 5 (pain threshold); (2) the same parameters at induced contraction start; (3) CSA where the pressure started to increase (CSAP>baseline) and (4) the number of contractions. The time, CSA, r/r0 and tension to reach VAS = 1 and VAS = 3 increased from distension 1 to 3 (4.9 < F < 11.5, 0.05 > P > 0.007), primarily due to difference between the first and second distension. For VAS = 5, r/r0 was smaller in distension 3 than distension 1 (P < 0.05), whereas time, CSA and tension did not differ between distensions (P > 0.5). Compared with distension 1, CSA, r/r0 and tension at contraction start, and CSAP>baseline were bigger in distensions 2 and 3 (5.5 < F < 10.9, 0.05 > P > 0.009). The pressure to reach the VAS levels, the contraction numbers and pressure at contraction start did not differ among distensions (P > 0.6). During mechanical preconditioning, CSA, tension and deformation increased at sub-pain levels, reflecting sensory adaptation. The data point to acute remodeling of a strain-dependent mechanism in the rectal wall.

Delayed Rapid-Onset Capsular Bag Distension Syndrome

Delayed Rapid-Onset Capsular Bag Distension Syndrome

Синдром растяжения капсульного мешка: причины возникновения и методы устранения

Синдром растяжения капсульного мешка: причины возникновения и методы устранения

Virtual Eye Simulation: An Aid in Evaluation of Capsular Block Syndrome

Objective: To demonstrate the findings of three consecutive cases of postoperative Capsular Block Syndrome (CBS) diagnosed with the aid of Pentacam virtual eye simulation images. Methods: Observational case series report. Three patients underwent uneventful cataract removal and presented with blurry vision ranging from 4 days to 5 years after the surgeries were performed. Results: In a case of early-onset postoperative CBS, virtual eye simulation images clearly revealed a reduced posterior chamber depth caused by the accumulation of transparent fluid in the area between the intraocular lens and the posterior capsule. In two cases of late-onset postoperative CBS, virtual eye simulation images better visualized the alignment between intraocular lens (IOL) and iris than slit lamp examination and Schiemflug images. All three of the cases underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, and their capsular bag distensions were resolved immediately. The patients with misalignments between IOL and iris experienced more improvement in best-corrected visual acuity as opposed to the one who did not. Conclusion: Virtual eye simulation is found to be a useful way in visualizing misalignment between IOL and iris and assisting diagnoses of both early- and late-onset postoperative capsular block syndrome.

Lenticular Imaging: A New Experimental and Quantitative Analysis of Capsular Dynamics, "Choi-Apple View".

PurposeDevelopment of a means for quantitative estimation of lenticular and zonular dynamics by using real-time imaging of human autopsy eyes during implantation of different intraocular lens (IOL) models.MethodsIsolated lenticular structures from human autopsy eyes were prepared in vitro. The following IOLs were implanted: a one-piece C-loop haptic IOL, a three-piece C-loop haptic IOL, and a one-piece plate-type IOL. The amount of deformation of lenticular structures during implantation was calculated and the movements visualized with two cameras. The results were transformed to two-dimensional graphs using a newly developed image-processing algorithm.ResultsFor both one-piece plate-type and one-piece C-loop haptic IOLs, the amount of capsular bag deformation from its initial shape was greater in the direction of posterior center of the capsule, as detected by side camera, than in the direction of the equator (or periphery), as detected by front camera. The mean peak deformation values were 51% and 36% (as measured by side and front cameras, respectively) for one-piece plate-type IOL and 25% and 20% for one-piece C-loop haptic IOL. For three-piece C-loop haptic IOL, the capsular bag distention was almost equal in both posterior and peripheral directions, with mean peak deformation values reaching 39% and 38%.ConclusionsThe new experimental means of lenticular imaging and quantified dynamics from two different angles allowed three-dimensional understanding of specific behavior of each IOL. Our model not only exposes the capsular bag for recording during implantation, but also objectively compares the individual movement values and reveals different zonular and capsular stress patterns, depending on IOL model.Translational RelevanceThe novel “Choi-Apple View” allows a three-dimensional quantitative analysis of capsular dynamics and IOL implantation behavior.