A Novel Approach To The Management Of Intra-Operative Capsular Block Syndrome Using A Lens Snare (Zeiss Miloop)

We report a case of sudden-onset intraoperative capsular block syndrome with markedly elevated intraocular pressure managed by mechanical division of the subluxed nuclear sclerotic cataract, avoiding the need for pars plana vitrectomy or instrumentation.

Norfolk and Norwich University Hospital NHS Foundation Trust, UK.

A patient with a background of diabetic macular oedema and uveitis underwent phacoemulsification. During hydrodissection, the crystalline lens suddenly subluxed from the capsular bag. Attempts were made to relocate the lens back into the bag with the hydrodissection cannula and viscoelastic (Healon GV Pro) without success. This finding, along with a very shallow anterior chamber and new patient discomfort raised the concerns of a suprachoroidal haemorrhage. The operation was abandoned and referred urgently to the main regional hospital with in IOP of 70 mmHg. B-scan ultrasonography showed a distended posterior capsule (without rupture) and an anteriorly dislocated crystalline lens with no sign of suprachoroidal haemorrhage.

The patient was taken back to theatre where they were able to reform the anterior chamber sufficiently with Healon GV Pro, enough to allow insertion of the Zeiss miLOOP device which was threaded around the crystalline lens and used to divide it mechanically. Phacoemulsification of the segments was then completed and a one-piece intraocular lens was inserted. The patient was discharged same day with topical dexamethasone drops and ketorolac, alongside planned oral prednisolone. Day 1 follow up revealed expected AC inflammation and some cornea oedema with a pressure of 10mmHg. The patient had a visual acuity of 6/19 at 6 months postop, limited due to diabetic macular oedema.

A variety of different hydrodissection techniques have been suggested and perhaps this holds the key to reducing the risks, but this case certainly demonstrated an effective, novel use of the Zeiss miLOOP in intra-operative capsular block syndrome when it occurred.