A Case of Late-onset Capsular Block Syndrome, Resulting in the Misdiagnosis of Intraocular Lens Opacity

PURPOSE: We report a case of late-onset capsular block syndrome, which resulted in a misdiagnosis of intraocular lens (IOL) opacity. CASE SUMMARY: A 59-year-old man visited our clinic with reduced visual acuity in the right eye from 1 year prior. He had undergone uncomplicated bilateral cataract surgery by phacoemulsification with IOL implants at another hospital 10 years before. There was no specific history with the exception of hypertension. After being diagnosed in the ophthalmology clinic with IOL degeneration and opacity in the right eye, he was referred to our hospital for IOL replacement. Upon examination, his right uncorrected visual acuity was 0.06 and intraocular pressure was 22 mmHg. The refractive error could not be checked due to IOL opacity. Slit-lamp microscopy revealed a cloudy, milky IOL. Anterior-segment optical coherence tomography of the right eye showed retention of a highly reflective material in the lens capsule behind the IOL. Posterior capsule enlargement of the right eye was confirmed on ultrasound biomicroscopy. After neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy was performed, the homogeneous space disappeared and the eye recovered normal visual acuity. CONCLUSIONS: Capsular block syndrome is a rare complication that can occur shortly (1 day to 2 days) after cataract surgery. Late-onset capsular block syndrome, which occurs 10 years after surgery differs from typical clinical manifestations. Thus, capsular block syndrome is an important consideration upon the presentation of opacification due to IOL degeneration.

Effect of Nd:YAG laser treatment for early stage capsular block syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To evaluate the clinical outcomes of Nd:YAG laser capsulotomy in the treatment of early stage capsular block syndrome ( CBS) .?METHODS:Eighteen patients (21 eyes) with early stage capsular block syndrome were treated using Nd:YAG laser by anterior capsulotomy only or combined with posterior capsulotomy from January 2010 to July 2015 in Anyang Eye Hospital. Uncorrected distance visual acuity, intraocular pressure, spherical equivalent, depth of anterior chamber were observed preoperatively and 2wk postoperatively.?RESULTS:Seventeen eyes simply underwent peripheral anterior capsulotomy with Nd:YAG laser. Four eyes were combined with posterior capsulotomy. Compared with preoperative, uncorrected distance visual acuity improved, intraocular pressure returned to normal, degree of myopia reduced, depth of anterior chamber had deepened.? CONCLUSION: Nd: YAG laser capsulotomy is an effective treatment for early stage capsular block syndrome.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

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.

Early Capsular Block Syndrome after Phacoemulsification with Posterior Chamber IOL Insertion Combined with Vitrectomy

PURPOSE: To report early capsular block syndrome (CBS) after phacoemulsification with posterior chamber intraocular lens (IOL) insertion combined with vitrectomy. METHODS: Medical records of 622 eyes of 589 patients who had combined phacoemulsification, IOL implantation and vitrectomy between March 2009 and December 2011 were retrospectively reviewed. Among patients with CBS occurring within 1 month of surgery, the patient's baseline characteristics, type of IOL and ophthalmic viscoelastic devices were analyzed. RESULTS: Nine patients (1.45%) developed CBS with typical capsular bag distension. All CBS occurred within 2 weeks after the surgery. Hydrophilic, large optics and no angulation between optic and haptic were related with the occurrence of CBS. Nd:YAG laser capsulotomy (5 eyes), and surgical capsulectomy (2 eyes) resolved CBS successfully. In 2 eyes with gas tamponade, CBS resolved without intervention with the absorption of gas. CONCLUSIONS: CBS may develop after phacoemulsification with PC IOL insertion combined with vitrectomy and/or vitreous tamponade. Hydrophilic material, large optics and no angulation were risk factors of capsular block by enhancing adhesion between the capsulorrhexis and the optic.

Continuous curvilinear capsulorhexis and capsular block syndrome / 眼科新进展

Objective　To analysis the relation of the diameter of continuous curvilinear capsulorhexis and other factors with the capsular block syndrome.Methods　We not only analyzed the etiology and clinical characteristic of six cases in intraoperative,early postoperative and lately postoperative,but also discussed the method of treatment.Results　(1)When the diameter of CCC was smaller than the one of IOL's optic , the CBS easily happened; (2)When the hoops of the hydroview IOL had a smaller anterior angle and larger optic, the CBS easily happened; (3)When the viscoelestic material and cortex were stayed in capsular or anterior chamber, the CBS easily happened.Conclusion　(1)Generaly speaking the size of the CCC should right on the edge of the IOL's optic part; (2)To hydroview IOL, we should choose the one which had a larger anterior angle and a smaller optic; (3)Viscoelastic material which should be cleaned and there was no the rest cortex stayed in the capsular.