Diagnosis And Management Of A Late-Onset Capsular Bag Distension Syndrome : A Rare Entity That Should Not Be Missed

To describe the symptoms, the slit-lamp appearance and the management of a late-onset capsular bag distension syndrome (CBDS), occurring 5 years after an uncomplicated cataract surgery; and to discuss its literature

Ophthalmology Department, Hôpital Militaire Oued Eddahab Agadir, CHU Souss Massa, Agadir, Morocco. 

We report the case of a 68-year-old woman, with a history of bilateral uneventful cataract surgery 6 years ago, who presented to the ophthalmology department for a gradual vision loss of her right eye (RE), foggier than the fellow eye, associated with a chronic irritation

Ophthalmic examination revealed a plano refraction for the left eye (LE), and a myopic shift with a spherical refractive error of -1,75 for the RE. Uncorrected visual acuity was 20/20 in LE and 20/40 in RE. Slit-lamp examination of the RE revealed a whitish opaque fluid between the intraocular lens, and the posterior capsule. The capsulorhexis seemed to overlay the optic edges on 360 degrees. There was no anterior displacement of the lens-iris diaphragm. RE intraocular pressure was 18 mmHg. A diagnosis of late onset capsular bag distension syndrome was made. We successfully managed it with a Yag Laser capsulotomy, which permitted the evacuation of the fluid into the vitreous cavity. Patient recovered 20/20 UCVA due to the hyperopic shift

CBDS remains an underdiagnosed and rare complication of cataract surgery. It is often secondary to the accumulation of turbid fluid between the IOL and the posterior capsule and can occur within days to years after the initial surgery. Its physiopathology remains obscure, and mainly incriminates high irrigation pressures during surgery and incomplete viscoelastic removal behind the lens. The main risk factors encountered in literature are the complete overlap of the optic of the IOL by the capsulorhexis, and the 4 haptics IOls, as both are present in our case. Treatment often involves Yag laser capsulotomy. One should keep in mind the pathognomonic aspect of the CBDS, and think of it even many years after the surgery