The Milky Way - A Late Complication Of Cataract Surgery

Post-cataract IOL related visual acuity decrease can be caused by a variety of reasons. One rare complication is an accumulation of turbid, milky fluid behind the IOL in the capsular bag, which is part of the spectrum of capsular block syndrome. This complication can happen days, months, or years after cataract surgery. The turbid fluid can be a consequence of remaining viscoelastic material or opacified lenticular matter. Vision loss can result from opalescent fluid, scattering light and/or refractive change.

Ophthalmology Divison, Rabin Medical Center, Petah Tikva, Israel.

 An 83-year-old man who had cataract surgery on his right eye years prior to his complaints of decreasing vision.  Initially, he was erroneously diagnosed with IOL opacification and was considered for IOL exchange. Following his examination in our clinic, we realized that his IOL was clear, but a turbid fluid is present behind his intra capsular IOL. Diagnosis was made clinically using a slit lamp examination and confirmed by anterior segment OCT.

The patient underwent capsular wash in the operating room. During surgery, a gentle separation was made between the fibrous anterior capsule and the IOL. The turbid fluid was washed and clearing of it was demonstrated by intraoperative OCT. Post-operative visual acuity improved back to baseline. There is a supplemental movie that describes our surgical approach.

Turbid fluid accumulation behind the IOL is a rare complication after cataract surgery. It is important to be aware and be able to differentiate it from other reasons as posterior capsular opacification or IOL opacification in order to avoid unnecessary and risky IOL exchange surgery. We will discuss the pathophysiology, differential diagnosis, and treatment options (YAG versus surgical wash) of this entity.