Síndrome de distensión de la bolsa capsular: del diagnóstico al tratamiento / Capsular bursa distension síndrome: from diagnosis to treatment

El síndrome de distensión de la bolsa capsular es una rara complicación de la cirugía de catarata. El objetivo principal fue exponer los principales hallazgos oftalmológicos de esta enfermedad, y las diferentes alternativas de diagnóstico y tratamiento para afrontar esta infrecuente y tardía complicación de la cirugía de catarata. Consiste en la adhesión del borde de la capsulorrexis al lente intraocular, colocado en un saco capsular. Tal aposición dificulta que el líquido fluya a través de la apertura de la cápsula anterior y se acumule en el saco capsular. Se presenta un paciente masculino de 71 años con antecedentes de cirugía de catarata por facoemulsificación en el ojo derecho. Refirió que desde hace 11 meses ha notado disminución de la visión. En el examen oftalmológico del ojo derecho se constató agudeza visual sin corrección de 0,3 por cartilla de Snellen, la cual mejoró a 1,0 con una corrección de -1,00 dioptría D. La exploración con lámpara de hendidura descartó cualquier tipo de inflamación del segmento anterior. Su presión intraocular fue de 18 mmHg. Mostró una cámara anterior poco profunda, con un desplazamiento anterior del iris y un saco capsular distendido. La cápsula posterior estaba separada de la superficie posterior del LIO con contenido líquido transparente. Se diagnosticó síndrome de distensión de la bolsa capsular. Se sometió a una capsulotomía posterior con láser Nd: YAG. En la evaluación posterior, el paciente mostró agudezas visuales no corregidas de 1,0 por cartilla de Snellen en ambos ojos. El síndrome de distensión de la bolsa capsular es una complicación tardía e infrecuente de cirugía de catarata con múltiples factores de riesgo, pero de rápida solución(AU)

Capsular bag distension syndrome is a rare complication of cataract surgery. The main objective was to expose the main ophthalmological findings of this disease and the different diagnostic and treatment alternatives to deal with this infrequent and late complication of cataract surgery. It consists of adhesion of the capsulorhexis rim to the intraocular lens, placed in a capsular bag. Such apposition makes it difficult for fluid to flow through the anterior capsule opening and accumulate in the capsular sac. We present a 71-year-old male patient with a history of cataract surgery by phacoemulsification in the right eye who 11 months ago reported decreased vision in the same eye. The ophthalmologic examination of the right eye showed an uncorrected visual acuity of 0.3 by Snellen chart, which improved to 1.0 with a correction of -1.00 D diopter. Slit lamp examination ruled out any type of anterior segment inflammation. His intraocular pressure was 18 mmHg. She showed a shallow anterior chamber, with an anterior displacement of the iris and a distended capsular sac. The posterior capsule was separated from the posterior surface of the IOL with clear fluid content. Capsular bag distension syndrome was diagnosed. He underwent posterior capsulotomy with Nd: YAG laser. On further evaluation, the patient had uncorrected visual acuities of 1.0 by Snellen chart in both eyes. Capsular bag distension syndrome is a late and infrequent complication of cataract surgery with multiple risk factors, but with rapid resolution(AU)

Comparison of Sono-guided Capsular Distension with Fluoroscopically Capsular Distension in Adhesive Capsulitis of Shoulder

OBJECTIVE: To investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder. METHOD: In this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection. RESULTS: The VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension. CONCLUSION: Sono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.

Comparison of Intraarticular Steroid Injection with and without Capsular Distension in Adhesive Capsulitis of the Shoulder

OBJECTIVE: To compare intraarticular steroid injection with and without capsular distension in the treatment of adhesive capsulitis of the shoulder METHOD: Fifty-five cases those were clinically diagnosed as adhesive capsulitis of the shoulder were randomly assigned to one of two treatment groups. 28 cases were treated by intraarticular steroid injection with capsular distension (group 1) and 27 cases by steroid injection alone (group 2). They were evaluated by visual analogue scales, Cyriax stages of arthritis, and active shoulder range of motion (flexion, abduction, external rotation and internal rotation). Follow up assessments were made one week and one month after injection. RESULTS: There were no statistically significant differences in Cyriax stages and VAS between two groups. But in the group 1, shoulder range of motion showed significant improvement in flexion and internal rotation at one week, and flexion at one month. CONCLUSION: Intraarticular steroid injection with cspsular distension had no advantage over steroid injection alone in pain reduction, but can help the patients to achieve better range of motion, especially flexion and internal rotation, in treatment of adhesive capsulitis of the shoulder.