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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 194-195 |
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Late-onset capsular block syndrome after cataract surgery
Xiao Yang, Tianyi Chen, Yuanzhi Chen
Jinan Mingshui Eye Hospital, Shandong, China
| Date of Submission | 29-Jun-2022 |
| Date of Acceptance | 16-Aug-2022 |
| Date of Web Publication | 20-Jan-2023 |
Correspondence Address:
Yuanzhi Chen
Jinan Mingshui Eye Hospital, Shandong
China
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1574_22
Keywords: Capsular block syndrome, cataract surgery, Lateonset
How to cite this article:
Yang X, Chen T, Chen Y. Late-onset capsular block syndrome after cataract surgery. Indian J Ophthalmol Case Rep 2023;3:194-5 |
A 51-year-old male presented with chief complaints of right-eye diminution of vision since 20 days. He had undergone a phacoemulsification procedure in the right eye 6 years ago. Upon ophthalmologic evaluation, he was found to have an uncorrected visual acuity of 20/60 (LogMAR 0.48) in his right eye, which did not improve with a −3.00 D spherical correction. Slit-lamp examination ruled out any type of anterior segment inflammation. His Goldmann intraocular pressure (IOP) was 16 mmHg. Slit-lamp microscopy showed a fibrotic anterior capsule opening and a distended posterior capsular bag, which was full of untransparent liquid [Figure 1]. The high density of the opaque substance between the posterior surface of PC-IOL and the posterior capsule was verified via anterior optical coherence tomography (OCT). The yellow arrow indicates the anterior surface of PC-IOL, and the red vertical line indicates the opaque substance [Figure 2]. | Figure 1: Slit-lamp microscopy showed fibrotic anterior capsule opening and a distended posterior capsular bag, which was full of untransparent liquid
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 | Figure 2: The high density of the opaque substance between the posterior surface of PC-IOL and posterior capsule was verified via OCT. The yellow arrow indicates the anterior surface of PC-IOL, and the red vertical line indicates the opaque substance
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After surgical treatment, the intracapsular fluid turned clear, and the posterior capsule was attached to the posterior surface of PC-IOL [Figure 3]. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy [Figure 4]. On subsequent evaluation, the patient had uncorrected visual acuities of 20/20 (LogMAR 0) in the right eye. There were no complications during the procedure or the postoperative follow-up period. | Figure 3: After surgical treatment, the intracapsular fluid turned clear, and the posterior capsule was attached to the posterior surface of PC-IOL
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 | Figure 4: Anterior segment photography of the right eye after Nd:YAG capsulotomy
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| Discucssion | |  |
According to the clinical characteristics described by Kim and Shin, postoperative CBS can be divided into three types.[1] Late CBS occurs about 3.8 years after cataract surgery, although some case reports have described onsets as late as 12 years after the procedure.[2],[3]
Late-onset CBS occurred long-term after cataract surgery and may not be noticed until visual acuity is compromised. Nd:YAG anterior capsulotomy and posterior capsulotomy were suggested as treatment options for CBS. Durak et al.[4] reported success rates for anterior capsulotomy (50%) and posterior capsulotomy (100%). Joong Sik Koh et al.[5] preferred anterior capsulotomy as a first-line treatment for late-onset capsular block syndrome (CBS) without posterior capsule opacification (PCO). When PCO is present, the CBS could recur, for which Nd:YAG posterior capsulotomy was considered effective. However, some cases may need a surgical approach to remove the material when laser capsulotomy is not feasible owing to some reasons such as when the opaque material blocks the path of the laser to the posterior lens capsule or the discomfort from patients.[6],[7] Meanwhile, several severe complications could emerge and may even cause dissemination of intraocular infection.[1],[8] In our study, considering that the dark-white liquid makes it nearly impossible to aim the Nd:YAG laser, we chose a surgical approach. The opaque material was aspirated using a coaxial irrigation/aspiration handpiece. After surgery, we performed Nd:YAG posterior capsulotomy for PCO.
On the basis of this case, the patient underwent surgical treatment to wash untransparent liquid, which has been shown to be effective for late-onset CBS in which the dark-white liquid makes it nearly impossible to aim the Nd:YAG laser. After surgery, posterior capsulotomy with a Nd:YAG laser was considered safe and effective. At the same time, detailed clinical evaluation including careful slit-lamp examination and OCT examination is of paramount importance in the diagnosis of late-onset CBS.[9],[10]
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 | | |
| 1. | Kim HK, Shin JP. Capsular block syndrome after cataract surgery: Clinical analysis and classification. J Cataract Refract Surg 2008;34:357-63.  |
| 2. | Zhu XJ, Zhang KK, Yang J, Ye HF, Lu Y. Scheimpflug imaging of ultra-late postoperative capsular block syndrome. Eye (Lond) 2014;28:900-4. |
| 3. | Sia DI, Gilhotra J. Late-onset capsular block syndrome. Int Ophthalmol 2012;32:455-7. |
| 4. | Durak I, Ozbek Z, Ferliel ST, Oner FH, Söylev M. Early postoperative capsular block syndrome. J Cataract Refract Surg 2001;27:555-9. |
| 5. | Koh JS, Song YB, Wee WR, Han YK. Recurrent late-onset fibrotic capsular block syndrome after neodymium-yttrium-aluminum-garnet laser anterior capsulotomy: A case report. BMC Ophthalmol 2016;16:86. |
| 6. | Yang MK, Wee WR, Kwon JW, Han YK. Anterior chamber depth and refractive change in late postoperative capsular bag distension syndrome: A retrospective analysis. PLoS One 2015;10:e0125895. |
| 7. | Huang Y, Ye Z, Li H, Li Z. Outcome of surgical treatment in late-onset capsular block syndrome. J Ophthalmol 2017;2017:1847179. doi: 10.1155/2017/1847179. |
| 8. | Jain R, Grewal D, Gupta R. Scheimpflug imaging in late capsular. Am J Ophthalmol 2007;142:1083-5. |
| 9. | Pinsard L, Rougier MB, Colin J. Neodymium YAG laser treatment of late capsular block syndrome. J Cataract Refract Surg 2011;37:2079-80. |
| 10. | Pinarci EY, Bayar SA, Sizmaz S, Canan H, Yilmaz G. Late capsular block syndrome presenting with posterior cap sule opacifification. J Cataract Refract Surg 2012;38:672-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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