Capsular Bag Distension Syndrome 10 Years After Phacoemulsification And Intraocular Lens Implantation

To present a successful treatment case of capsular bag distension in an eye a decade after cataract surgery

Department of Ophthalmology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics

A 85 year old bilaterally pseudophakic male patient was referred to our clinic complaining of blurred and gradual, painless vision reduction in his left eye (LE) over the past few months. The patient underwent uneventful cataract surgery on both eyes 10 years earlier. Visual acuity (VA) was 1.0 of the right eye (RE) and 0.8 of the LE. Slit-lamp biomicroscopic examination of the RE was unremarkable, however, in the LE a turbid, milky opacity between the IOL and the posterior capsule was noticed. Due to strong opacity, we were not able to to perform fundoscopic examination, however fundus reflex was positive. Anterior chamber optical coherence tomography (AS-OCT) imaging, Scheimpflug imaging (Oculus Pentacam) and optical biometry with IOLMaster® (Zeiss Meditec AG, Jena, Germany) were performed, showing distension of the posterior capsule and hyperreflective material between it and the IOL.

Nd:YAG posterior capsulotomy was performed, milky fluid flew out from the subcapsular space into vitreous. VA improved to 1.0 on day 1. The patient was pleased with the clarity of his vision and reported no further symptoms of visual haze or bluriness.

This case highlights the successful treatment of capsular bag distension a decade after cataract surgery. Nd:YAG posterior capsulotomy safely and effectively resolved the patient’s symptoms, improving visual acuity and patient satisfaction. It underscores the importance of recognizing delayed complications in pseudophakic patients and the potential for successful intervention long after surgery. We also determined that  optical biometry with IOLMaster® was superior in diagnostic of this syndrome to Scheimpflug imaging (Oculus Pentacam) and AS-OCT.