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.

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.

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.

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.

Early postoperative capsular block syndrome

Early postoperative capsular block syndrome

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.

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

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 after cataract surgery: Clinical analysis and classification

To study the incidence of and risk factors for postoperative capsular block syndrome (CBS) and propose a new classification based on etiology. Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea. Charts of 1100 eyes of 990 patients who had phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation between January 2003 and June 2006 were retrospectively reviewed. Demographic data, axial length (AL), type of PC IOL implanted, and intraoperative ophthalmic viscosurgical devices (OVDs) were recorded. The cases of postoperative CBS were collected and the characteristic clinical findings evaluated. There were 8 cases (7 patients) of postoperative CBS (incidence 0.73%). Longer AL (>or=25.0 mm) was a risk factor for postoperative CBS (P= .008; odds ratio [OR], 5.75, 95% confidence interval [CI], 1.353-24.413). The PC IOL with 4 haptics (Akreos Adapt, Bausch & Lomb) was also associated with an increased incidence of postoperative CBS (P= .001; OR, 7.388; 95% CI, 1.751-31.168). The CBS was classified as noncellular, inflammatory, or fibrotic according to the clinical characteristics. Although postoperative CBS was a rare complication after cataract surgery, AL and PC IOL design had a significant influence on the incidence. Evaluation of clinical characteristics showed 3 distinct types of CBS.

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。

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.

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.