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PHOTO ESSAY
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 192-193

Multimodality imaging technique for capsular bag distension syndrome


Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission28-Jun-2022
Date of Acceptance16-Aug-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Madhu Shekhar
Chief, Cataract and IOL Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1564_22

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  Abstract 


Keywords: Capsular bag distension syndrome, cataract, continuous curvilinear capsulorhexis, Nd: YAG laser, posterior chamber intraocular lens


How to cite this article:
Waghamare SR, Bhanumathi H S, Nagu K, Shekhar M. Multimodality imaging technique for capsular bag distension syndrome. Indian J Ophthalmol Case Rep 2023;3:192-3

How to cite this URL:
Waghamare SR, Bhanumathi H S, Nagu K, Shekhar M. Multimodality imaging technique for capsular bag distension syndrome. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:192-3. Available from: https://www.ijoreports.in/text.asp?2023/3/1/192/368153



Capsular bag distension syndrome (CBDS) is one of the complications of continuous curvilinear capsulorhexis (CCC) and retained cortical material following cataract surgery.[1] Herein, we present multimodal imaging features of a classic late-onset CBDS case. A 67-year-old male presented with blurred vision in right eye (RE) for 6 months. He underwent bilateral uncomplicated phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation 15 years back. Best-corrected visual acuity (BCVA) was 6/6(p) with − 1.5 DS in RE and 6/6 in left eye (LE). Slit-lamp examination of RE revealed PCIOL with collection of turbid fluid between the PCIOL and posterior capsule (PC) with retained cortical material [Figure 1]a and [Figure 1]c. RE fundus was partially obscured due to hazy media. LE was unremarkable. Swept source-optical coherence tomography (SS-OCT) and ultrasound biomicroscopy [Figure 1]b and [Figure 1]d confirmed the diagnosis of RE CBDS. PC of RE was breached by neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. Turbid fluid rapidly egressed into the vitreous cavity with resolution of CBDS. Post-laser RE BCVA was 6/6 with − 1.0 DS.
Figure 1: (a) Diffuse slit-lamp image of turbid fluid between the posterior surface of IOL and posterior capsule with retained cortical material. (b) IOL Master 700 SS-OCT showing hyperreflective material between the PCIOL and posterior capsule. (c) Slit image of turbid fluid between the posterior surface of IOL and posterior capsule with retained cortical material. (d) UBM showing distension of posterior capsule and clear space between the PCIOL and posterior capsule IOL = intraocular lens, PCIOL = posterior chamber intraocular lens, SS-OCT = swept source-optical coherence tomography

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  Discussion Top


CBDS can be classified as intraoperative, early, and late onset, depending on the time of presentation. The average time of presentation of late-onset CBDS is 3.8 years.[2] In late-onset CBDS, turbid fluid is trapped between the PCIOL and PC due to adherence of intraocular lens (IOL) optic and capsular opening following CCC. Earlier studies have concluded that the fluid is due to proliferation and metaplasia of residual lens epithelial cells (LECs) which produce various collagen and extracellular substances.[3] Electrophoresis of the fluid demonstrated presence of α-crystallin and albumin, suggesting that the fluid is derived from LECs.[1] Unlike in the intraoperative and early-onset CBDS, late-onset CBDS has relatively normal intraocular pressure (IOP) and anterior chamber depth. Various treatment modalities are available, of which we have performed Nd: YAG laser capsulotomy with a short course of steroids.[4],[5] The risk involved is pouring of proteins or bacteria, especially Propionibacterium acnes, in the vitreous cavity, leading to inflammation or endophthalmitis, which was not seen in our case.[6] Various noninvasive imaging options, such as anterior segment OCT, Ultrasound Biomicroscopy (UBM), and Scheimpflug imaging, have been used for diagnosing CBDS.[4],[7] Our case was diagnosed clinically and confirmed by multimodal imaging (SS-OCT by IOLMaster 700 and UBM). IOLMaster 700 is a noncontact optical biometer which, along with measurement of axial length by SS-OCT technology, has an additional feature of cornea to retina scan, allowing visualization of anterior segment and macula.[8] These easy imaging techniques differentiated CBDS from PC opacification and vitritis. Here, we see a delayed presentation of 15 years, which was successfully treated with cost-effective and noninvasive Nd: YAG laser capsulotomy procedure.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Eifrig DE. Capsulorhexis-related lacteocrumenasia. J Cataract Refract Surg 1997;23:450-4.  Back to cited text no. 1
    
2.
Galvin JC, Berdoukas P, Fung AT. Two cases of very late-onset capsular bag distension syndrome. Am J Ophthalmol Case Rep 2018;10:268-70.  Back to cited text no. 2
    
3.
Miyake K, Ota I, Ichihashi S, Miyake S, Tanaka Y, Terasaki H. New classification of capsular block syndrome. J Cataract Refract Surg 1998;24:1230-4.  Back to cited text no. 3
    
4.
Kanclerz P, Wang X. Postoperative capsular bag distension syndrome–risk factors and treatment. Semin Ophthalmol 2019;34:409-19.  Back to cited text no. 4
    
5.
Grover DS, Goldberg RA, Ayres B, Fantes F. Treatment of late-onset capsular distension syndrome with a neodymium: YAG laser peripheral iridotomy and anterior capsulotomy. J Cataract Refract Surg 2012;38:938-40.  Back to cited text no. 5
    
6.
Kollias AN, Vogel MA, de Kaspar HM, Lackerbauer CA, Grueterich M. Propionibacterium acnes in capsular bag distension syndrome. J Cataract Refract Surg 2010;36:167-9.  Back to cited text no. 6
    
7.
Tan YL, Mohanram LS, Ti SE, Aung T, Perera S. Imaging late capsular bag distension syndrome: An anterior segment optical coherence tomography study. Clin Ophthalmol (Auckland, NZ) 2012;6:1455-8.  Back to cited text no. 7
    
8.
Hirnschall N, Leisser C, Radda S, Maedel S, Findl O. Macular disease detection with a swept-source optical coherence tomography-based biometry device in patients scheduled for cataract surgery. J Cataract Refract Surg 2016;42:530-6.  Back to cited text no. 8
    


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