Late Postoperative Capsular Block Syndrome Research Articles

Поздний синдром капсульного блока с гиперметропическим сдвигом. Клинический случай

Capsular block syndrome (CBS) is one of complications of modern cataract surgery technique, due to restriction of fluid passage from the capsular bag, which in different terms of postoperative period of cataract phacoemulsification may lead to reduction of both anatomical and functional results of surgery. The treatment of choice of the capsular block syndrome, especially during early postoperative period, is YAG laser dissection of the posterior capsule, which in most cases allows restoring transparency and refraction. In cases like lactocrumenasia (a variant of late CBS) it is not always possible to visualize the posterior capsule and evacuate the contents, therefore, the treatment of choice can be surgical dissection and aspiration of the contents. However, according to the literature, there is a possibility of infection of isolated capsule contents which obliges to correctly and carefully determine the surgical tactics in such cases. This article presents a rare case of late postoperative capsular block syndrome with hyperopic shift in a patient with proliferative diabetic retinopathy and silicone tamponade of the vitreous cavity. Key words: capsular block syndrome; hyperopic shift; cataract phacoemulsification.

Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy

To compare the clinical characteristics of eyes affected by late postoperative capsular block syndrome (CBS) after routine phacoemulsification or phacovitrectomy, and to demonstrate the outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy and posterior continuous curvilinear capsulorrhexis (PCCC) in the treatment of CBS. Retrospective interventional case series study. Twenty-eight patients with late postoperative CBS, comprising 13 eyes after phacoemulsification (Group A) and 15 eyes after phacovitrectomy (Group B), were analyzed. Seventeen patients with minimal (degree I), mild (II), and moderate (III) posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy (Group A, 10 eyes and Group B, 7 eyes), while 11 patients with severe (degree IV) PCO underwent PCCC (Group A, 3 eyes and Group B, 8 eyes). A statistically significant postoperative improvement in best-corrected visual acuity (Group A, P= .0002 and Group B, P= .0070) and a significant postoperative decrease in aqueous flare value (Group A, P= .0077 and Group B, P= .0127) were observed. No significant differences were observed in intraocular pressure, aqueous depth, and diopters (P > .05). No surgical complications were experienced by either group. Late postoperative CBS had similar characteristics whether it developed after phacoemulsification or after phacovitrectomy. Nd:YAG capsulotomy and the PCCC technique are efficient approaches to mild and moderate PCO and severe PCO with CBS, respectively. PCCC may be a viable alternative for treating dense PCO with CBS in pseudophakic eyes.

A case series of late postoperative capsular block syndrome treated by Nd:YAG laser posterior capsulotomy

AbstractPurpose To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of neodymium:yttrium‐aluminium‐garnet (Nd:YAG) laser posterior capsulotomy on visual acuity, refractive error as well as its possible complicationsMethods Retrospective cohort study. Twelve eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete examination including Scheimpflug camera and anterior segment optical coherence tomography (AS‐OCT) imaging had been performed before and after posterior capsulotomyResults BCVA increased in 11 cases (91.7%). Only one eye showed a 0.5 diopter hyperopic shift following posterior capsulotomy. There were no post‐laser complications such as increased IOP or cystoid macular edema. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. AS‐OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the IOLConclusion Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Although the AS‐OCT measurements are easier to get than Scheimplug imaging, both are useful to visualize the distended capsular bag containing the white material and the IOL position

Late postoperative capsular block syndrome: a case series studied before and after Nd:YAG laser posterior capsulotomy.

To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of Nd:YAG laser posterior capsulotomy on visual acuity and refractive error as well as its possible complications. In this retrospective cohort study, 12 eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete ophthalmic examination including Scheimpflug camera and anterior segment optical coherence tomography (AS-OCT) imaging had been performed before and after posterior capsulotomy. The mean time between cataract surgery and posterior capsulotomy was 4.7 ± 1.5 years (range 3-9 years). Best-corrected visual acuity increased in 11 cases (91.7%). Only one eye showed a 0.5-D hyperopic shift following posterior capsulotomy. There were no postlaser complications such as increased intraocular pressure (IOP), severe inflammation, cystoid macular edema, or retinal detachment. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. The AS-OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the intraocular lens (IOL). Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement, or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Furthermore, although AS-OCT measurements are easier to obtain than rotating Scheimpflug imaging examination, both are useful to visualize the distended capsular bag containing the white material and the IOL position.

Late capsular block syndrome presenting with posterior capsule opacification

To assess the results of posterior neodymium:YAG (Nd:YAG) laser capsulotomy in patients with late postoperative capsular block syndrome (CBS) with decreased vision because of posterior capsule opacification (PCO). Baskent University Hospital, Department of Ophthalmology, Ankara, Turkey. Case-control study. Patients with CBS who had phacoemulsification and foldable hydrophilic or hydrophobic acrylic intraocular lens implantation with continuous curvilinear capsulorhexis were retrospectively reviewed. Transparent to slight milky fluid had collected in the capsular bag. Capsular block syndrome was undiagnosed before the PCO developed. The CBS was treated with Nd:YAG laser capsulotomy, after which the change in refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and inflammation rate were evaluated. Follow-up examinations were at 1 day, 1 week, and 1 and 6 months. The mean time between cataract surgery and laser capsulotomy was 48 months ± 10.27 (SD) (range 28 to 66 months). The Nd:YAG capsulotomy was successful in all eyes. Capsulotomy did not change the refraction in 14 eyes (93.3%). One patient (6.6%) had a change of +0.75 diopter. After capsulotomy, the logMAR CDVA improved in 13 cases (mean 0.26 ± 0.18; range 0.0 to 0.7) and did not change in 2 cases. There were no complications, inflammation, or significant IOP changes. Neodymium:YAG laser capsulotomy in patients with PCO associated with late CBS increased visual acuity without a significant change in refraction or IOP. Capsular block syndrome may be asymptomatic and remain undiagnosed for a long time after cataract surgery before PCO develops.

Surgical management of late capsular block syndrome

To study the effect on visual acuity of surgical management of late capsular block syndrome (CBS) and the possible complications. Department of Ophthalmology, Peking University People's Hospital, Beijing, China. In this retrospective observational series, records of patients who had late postoperative CBS and surgical management between January 2006 and December 2009 at the same hospital were drawn from a computerized database and reviewed. The patient's baseline characteristics, corrected distance visual acuity, and intraocular pressure (IOP) before and after the surgery were analyzed. Corrected distance visual acuity improved after the surgery in all patients. No risk for increased IOP or phacoanaphylaxis endophthalmitis was noted. Initial findings with this surgical procedure indicate a potential treatment for late CBS; however, additional studies are needed before a firm conclusion can be drawn.

Late postoperative capsular block syndrome versus liquefied after-cataract

We report the case of a 76-year-old Chinese man who had uneventful cataract phacoemulsification and hydrophilic acrylic intraocular lens (IOL) implantation 6 years previously. He presented with decreased vision; a homogeneous milky substance was found between the posterior chamber IOL and the posterior capsule without IOL displacement or a change in the refractive status. The milky substance was aspirated from the capsular bag. Biochemical analysis showed the concentrations of proteins and Ca(++) in the milky liquid were higher than those in the aqueous humor. Protein identification by mass spectrometry indicated that the milky liquid contained a high concentration of alpha-crystallin and beta-crystallin.

Capsular block syndrome presenting with a hyperopic shift

We report a case of late postoperative capsular block syndrome presenting with a hyperopic shift and discuss possible causes of this unusual presentation.

Late postoperative capsular block syndrome: Entrapment of liquefied after-cataract by capsular bend

We report a case of capsular bend-related entrapment of liquefied after-cataract that resulted in late postoperative capsular block syndrome in a 56-year-old man. Slitlamp examination showed a capsular bend formation at the square edge of the optic. Superiorly, leakage in the capsular bend resulted in fluid extending into Soemmering's ring, although communication with the anterior chamber was limited by the capsular bend. Fluid was seen between the lens and posterior capsule.