Post Operative Capsular Bag Distension Syndrome With In The Sulcus Piol

The purpose of this case scenario is to report post operative capsular bag distension syndrome (CBDS) status post in the sulcus posterior chamber intra-ocular lens, its various do's and don'ts

This case was done in the community ophthalmology department recently in my training where CBDS is normally report with in the bag iol implantation but we confronted an exception to this dictum and seems the best learning to all readers from our experience

We present a case report of a 68 year old female patient who underwent uneventful cataract surgery. Examination revealed pseudophakic right eye with best corrected visual acquity of 6/9, left eye had intumescent mature cataract with perception of light + and perception of rays accurate in all quadrants, the patient was then taken up for manual small incision cataract surgery. Per operatively, lens decompression was done, turbid fluid drained, had positive pressure due to obese patient, could manage to do small 5 mm rhexxis. The surgery went uneventful but IOL was implanted in sulcus. Post operative day 1, uncorrected visual acquity (UCVA) was 6/12 with pin hole 6/9. But at day 7, vision dropped to finger counting to 2 metres, slit lamp examination revealed a tight extended bag with IOL optic covering the capsulorrhis symmetrically causing the block. Slit revealed a turbid whitish fluid suggesting remanents of intumescent mature cataract from equator resulting in distension of the bag. AS OCT (Anterion) confirmed the diagnosis. Staged treatment was done, which had Nd-YAG capsulotomy in first phase which got failed as posterior capsule was not visible because of turbid fluid. In such a situation, measurement was done using anterion which suggested distension of bag to the tune of approximately 450microns, thereby posterior shift of Nd YAG focus was attempted but went in vain. Phase 2, AC wash and in the bag IOL redialling was done, post operative BCVA 6/9 achieved.

In the sulcus IOL implantation also leads to Capsular Bag Distention Syndrome in cases like Intumescent Mature Cataract. Per operative good cortex wash should be done, capsulorhexis size holds due importance. If still, CBDS is confronted, a staged treatment protocol should be followed in the benefit of the visual health of the patient.

To the best of the author's knowledge, this is the first case scenario being reported till date worldwide of CBDS status post in the sulcus IOL implantation.