Early Postoperative Capsular Block Syndrome Research Articles

Time course of changes in anterior chamber structures after Nd:YAG laser anterior capsulotomy for early-onset postoperative capsular block syndrome evaluated by AS-OCT

A 69-year-old man underwent uncomplicated 25-gauge pars plana vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for treatment of epiretinal membrane. On postoperative day 1, a shallow anterior chamber and an anterior displacement of the IOL with pigment dispersion were observed. Swept-source anterior segment optical coherence tomography (AS-OCT) revealed a capsular hyperexpansion with ciliochoroidal detachment, and the patient was diagnosed with early-onset postoperative capsular block syndrome (CBS). After peripheral anterior capsulotomy by Nd:YAG laser on postoperative day 1, the IOL displacement was resolved immediately, and a transient reverse pupillary block was detected by AS-OCT. A resolution of the reverse pupillary block and ciliochoroidal detachment was confirmed by AS-OCT on postoperative day 3. To our knowledge, this is the first case that describes the postoperative time course and a transient reverse pupillary block after Nd:YAG anterior capsulotomy for early postoperative CBS using swept-source AS-OCT images.

Retro-intraocular Lens Irrigation-aspiration to Prevent Capsular Block Syndrome at the Hands of Novice Surgeons.

Retro-intraocular lens (IOL) irrigation-aspiration is of paramount importance in order to remove the viscoelastic substance from the retro-IOL space and to prevent any early post-operative capsular block syndrome. However, manoeuvring the IOL to reach the retro-IOL space may be difficult at the hands of novice surgeons despite the use of coaxial or bimanual irrigation-aspiration probes. We describe a simpler and safer technique in order to facilitate the removal of this retro-IOL viscoelastic substance using a 26-Gauge bent-cannula mounted on a 2-ml syringe. The fluid is injected forcefully along with sideways movement of cannula in a single-plane to displace the viscoelastic substance.

Early postoperative capsular block syndrome

Early postoperative capsular block syndrome

Nonarteritic ischemic optic neuropathy developed after capsular block syndrome

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.

The clinical study of early post-cataract surgery capsular block syndrome

Objective To discuss the causes,prevention and treatment of persistent high intraocular pressure caused by early capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation.Methods 54 patients who developed early postoperative CBS were included in this study.22 cases received anterior vitrectomy and anterior chamber gas injection,19 cases received YAG laser anterior or posterior capsulotomy,13 cases only received medication to drop intraocular pressure.Statistical data was analysed by SPSS 13.0 software package to compare the efficacy of treatment.Results The corrected visual acuity improved after one week of treatment,there was no significant difference between the three groups (P =0.594).The high intraocular pressure relieved,there was significant difference (P =0.048).After three months of follow-up,there was no significant difference between the three groups of corrected visual acuity (P =0.240),but there was significant difference of IOP (P =0.030).Furthermore,there was no significant difference of IOP between the vitrectomy group and laser group (P =0.725),but the IOP of the vitrectomy group and laser group was significantly better than that of medication group (P =0.004,P =0.033).Conclusion The early postoperative CBS can be prevented by expansion of capsulorhexis diameter,selecting appropriate intraocular lens,and improving surgical skills to complete removal of the viscoelastic material.When the medication fails,early operation of anterior vitrectomy and anterior chamber gas injection can effectively reduce intraocular pressure and improve corrected visual acuity,which may achieve the same effect of laser treatment. Key words: Post-cataract surgery; Capsular block syndrome; High intraocular pressure ; Anterior vitrectomy ; YAG laser

Photographic Essay

Capsular block syndrome (CBS) or capsular bag distension syndrome is characterized by distension of the capsular bag after uneventful phacoemulsification and endocapsular intraocular lens implantation. The syndrome has also been reported after extracapsular cataract extraction and intraocular lens placed in the sulcus. We report the anterior segment optical coherence tomographic findings in a case of early postoperative CBS. Anterior segment optical coherence tomographic aids in the diagnosis and management of CBS.

Treatment of early postoperative capsular block syndrome

目的 探讨人工晶状体术后早期囊袋阻滞综合征(capsular block syndrome,CBS)的临床表现、发生机制、治疗和预防方法.方法 收集超声乳化、人工晶状体囊袋内植入术后早期出现CBS者13例(13眼).首先尝试Nd:YAG激光周边前囊切开术;其中1例瞳孔不能散大无法暴露周边前囊,则改行激光后囊切开术.结果 13例CBS均表现出明显的撕囊口阻滞、囊袋高度扩张、人工晶状体前移位、浅前房和近视性漂移.除1例未经干预自行消失外,其余12例经Nd:YAG激光囊切开后CBS消失,前房深度平均加深(1.52±0.67)mm.结论 囊袋内黏弹剂残存是造成术后早期CBS的重要因素.激光周边前囊切开术、后囊切开术可安全、有效地治疗CBS。

Intraoperative peripheral anterior capsulotomy to prevent early postoperative capsular block syndrome

We describe a new surgical technique, intraoperative peripheral anterior capsulotomy (IPAC), to prevent early postoperative capsular block syndrome (CBS). Eighty consecutive patients (80 eyes) had phacoemulsification and intraocular lens implantation with IPAC in the presence of a small (4.5 to 5.0 mm) anterior continuous curvilinear capsulorhexis (CCC). Patients were followed for a mean of 16 months (range 6 to 24 months), and none developed CBS or other complications. Our series suggests that IPAC may be an alternative to prevent CBS in high-risk eyes, including those with a small anterior CCC or ophthalmic viscosurgical device material trapped in the capsular bag. This surgical technique is safe, effective, inexpensive, and easy to perform.

Capsular bag distention after implantation of foldable acrylic lenses

Incomplete removal of the viscoelastic material during cataract surgery may lead to the early postoperative capsular block syndrome. In this retrospective case series, postoperative capsular bag distention after implantation of a foldable acrylic lens is reported and the sequelae are analyzed. In a retrospective case series, 10 eyes of altogether 1674 eyes that underwent cataract surgery in the years 2001 and 2002 were identified with early postoperative capsular block syndrome. All 10 eyes had cataract removal with continuous curvilinear capsulorhexis, phacoemulsification and a foldable acrylic lens was placed in the capsular bag. In 4 of 10 eyes cataract extraction was combined with trabeculectomy. All patients had posterior Nd:YAG capsulotomy. Refraction was performed before and after capsulotomy. Postoperative examination showed capsular bag distention in all eyes. The mean postoperative spherical equivalent was -3.9 +/- 1.6 Dpt. As the target refraction was -1.2 +/- 1.0 Dpt there was an average of -2.7 +/- 1.4 Dpt of induced myopia. A mild increase in postoperative anterior chamber inflammation was noted only in 1 patient and shallowing of the anterior chamber was observed in another patient. Posterior Nd:YAG capsulotomy was performed 4.5 +/- 4.3 months after surgery. The mean refractive shift after Nd:YAG capsulotomy was 1.9 +/- 1.9 Dpt. Unexpected postoperative myopic correction was the main manifestation of capsular block syndrome in this series. Intraoperative use of miotics prohibiting optical control of complete viscoelastic removal may explain the high proportion of combined procedures. In the case of unexpected postoperative myopia the position of the intraocular lens within the bag should be checked and attention should be paid to possibly incompletely removed viscoelastic material.

Early postoperative capsular block syndrome

Purpose To report the results of early postoperative capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation. Setting Department of Ophthalmology, Dokuz Eylül University School of Medicine, İzmir, Turkey. Methods Thirteen eyes of 13 patients with CBS who had uneventful phacoemulsification were included in the study. Twelve patients had in-the-bag implantation of a foldable IOL, and 1 had implantation of a poly(methyl methacrylate) IOL in the ciliary sulcus. Continuous curvilinear capsulorhexis was performed in all eyes, and sodium hyaluronate 1.4% (Healon GV®) was used during all steps of surgery. The patients were closely followed without intervention during the first month after surgery. If resolution did not occur during follow-up, a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy was performed first, followed by posterior capsulotomy if the anterior capsulotomy was not successful. Results The CBS resolved without intervention in 2 eyes by 1 month postoperatively. A small Nd:YAG laser peripheral anterior capsulotomy was attempted in 10 cases after 1 month but could not be performed in 2 eyes because of inadequate pupil dilation. Peripheral anterior capsulotomy was successful in 5 of 8 eyes, with resolution of CBS in a few days. The Nd:YAG laser posterior capsulotomy was successful in 5 cases after the failure of the anterior capsulotomy. One patient chose to postpone treatment for 11 months, at which time posterior capsulotomy was performed successfully and the CBS resolved. Conclusions Resolution of CBS occurred spontaneously in only a small percentage of cases during the first month after phacoemulsification with IOL implantation. Neodymium:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating CBS.

Intraoperative peripheral anterior capsulotomy to prevent early postoperative capsular block syndrome

We describe a new surgical technique, intraoperative peripheral anterior capsulotomy (IPAC), to prevent early postoperative capsular block syndrome (CBS). Eighty consecutive patients (80 eyes) had phacoemulsification and intraocular lens implantation with IPAC in the presence of a small (4.5 to 5.0 mm) anterior continuous curvilinear capsulorhexis (CCC). Patients were followed for a mean of 16 months (range 6 to 24 months), and none developed CBS or other complications. Our series suggests that IPAC may be an alternative to prevent CBS in high-risk eyes, including those with a small anterior CCC or ophthalmic viscosurgical device material trapped in the capsular bag. This surgical technique is safe, effective, inexpensive, and easy to perform.

Analysis of liquid accumulated in the distended capsular bag in early postoperative capsular block syndrome

PurposeTo analyze the transparent liquid between the posterior lens capsule and the posterior chamber intraocular lens (PC IOL) in early postoperative capsular block syndrome and discuss the mechanism of posterior capsule distention. SettingDepartment of Ophthalmology, Tokyo University School of Medicine, and Tokyo Research Institute, Seikagaku Corporation, Tokyo, Japan. MethodsThis study evaluated 3 cases of capsular block syndrome presenting with transparent liquid in the distended capsular bag 1 day after cataract surgery. The transparent liquid material between the posterior capsule and PC IOL was aspirated and analyzed using high-performance liquid chromatography (HPLC). Also, sodium hyaluronate was diluted using a dialyzer to determine whether the aqueous humor was drawn into the capsular bag by an osmotic gradient across the capsule. ResultsThe elution time of the samples was almost the same as that of sodium hyaluronate 1.0% (Healon®) The concentration of the samples ranged from 3.29 to 9.01 mg/mL by HPLC analysis. The sodium hyaluronate absorbed the physiological salt solutions through the dialyzer and expanded to 1.9 times its original volume. ConclusionsThese results indicate that the main ingredient of the transparent liquid in capsular bags is sodium hyaluronate and that the distention is caused by aqueous humor being drawn into the capsular bag by an osmotic gradient across the capsule when the capsulorhexis diameter is smaller than that of the PC IOL and by viscoelastic material retained and trapped in the bag intraoperatively.

Early postoperative capsular block syndrome related to saccadic-eye-movement-induced fluid flow into the capsular bag

PurposeTo determine the relationship between saccadic eye movements and the development of early postoperative capsular block syndrome. SettingFundacion Oftalmologica, Los Andes, Santiago, Chile. MethodsAn artificial experimental setup was designed to reproduce the anatomical, hydrodynamic, and kinetic conditions of an early postoperative pseudophakic eye with a capsulorhexis and intracapsular intraocular lens (IOL) implantation. An electromechanical transducer driven by a digital-to-analog converter was used to mimic saccadic eye movements at physiological speeds and accelerations. Position information and differential pressure measurements between the intracapsular space and the extracapsular space were digitized. Various anterior capsule–IOL configurations were tested including partial adhesion of the anterior capsule to the lens. ResultsSaccadic movements increased intracapsular pressure by displacing fluid into the capsular bag. This finding was inconstant and only observed when the capsular rim adhered to the IOL optic by more than 70%. Development of positive intracapsular pressure was noted above 4 mm Hg. ConclusionA valve-like mechanism formed by the capsulorhexis rim partially adhered to the IOL optic can occur postoperatively. Under these conditions, saccadic eye movements can increase intracapsular pressure by a unidirectional inertial displacement of fluid into the capsular bag.