Surgical Management Of A Severe Case Of 10-Year Postoperative Capsular Bag Distension Syndrome
Published 2025 - 43rd Congress of the ESCRS
Reference: PO801 | Type: Poster | DOI: 10.82333/gbg0-w306
Authors: Efthymia Kalogera* 1 , Spyros Atzamoglou 2 , Evangelos Spanos 3 , Vasileios Peponis 1
11st Ophthalmology Department,Specialized Eye Hospital Ophthalmiatreio Athinon,Athens,Greece, 2Ophthalmology Department,Royal Victoria Infirmary,Newcastle upon Tyne,United Kingdom, 3Ophthalmology Department,Sismanoglio General Hospital,Athens,Greece
Purpose
To report a case of a late-onset capsular bag distension syndrome (CBDS), manifested 10 years after cataract surgery and treated with surgical aspiration.
Setting
Specialized Eye Hospital Ophthalmiatreio Athinon, Sina 2, Athens, Greece, 106 72
Methods
A 93-year-old male patient was referred to our hospital, misdiagnosed with posterior capsule opacification (PCO). His medical history includes uneventful cataract surgery in the left eye, with continuous curvilinear capsulorhexis and posterior intraocular lens (IOL) implantation in-the-bag 10 years ago. Best-corrected visual acuity (BCVA) was 5/10 and 2/10 for right and left eye, respectively. Slit-lamp examination of the left eye exhibited opaque milky-white fluid accumulation between the IOL and the posterior capsule, with no evidence of inflammation. A retrolenticular pseudohypopyon was also observed. Anterior chamber OCT revealed distension of the posterior capsule. Fundoscopy was unattainable due to the low transparency of the content.
Results
The clinical diagnosis was late postoperative CBDS. Nd:Yag laser posterior capsulotomy was unobtainable, due to the high density of the liquified material. Considering, also, the possible presence of Propionibacterium Acnes in the intraocular fluid, a surgical management was decided. An anterior approach was preferred through a clear corneal incision of 2,75mm and a paracentesis. A 360o dissection of the anterior capsule from the IOL surface was performed with a blunt instrument followed by aspiration of the milky fluid behind to IOL. Furthermore, a profound Soemmering’s ring was removed. Intraocular and topical antibiotics and steroids were administered. On the first postoperative day BCVA increased immediately to 6/10.
Conclusions
CBDS is an unusual cataract surgery complication and it is challenging to distinguish it from PCO. It can be classified based on the onset time as intraoperative, early and late postoperative1. Risk factors involve retained cortex and ophthalmic viscoelastic device, and small capsulorhexis2. Our case presented 10 years postoperatively, whilst the mean presentation is 3.8 years1. Diagnosis is clinical, with the assistance of multimodal imaging. Management includes observation, anterior or posterior capsulotomy and surgery. Although YAG-laser posterior capsulotomy is the standard of care, it can lead to inflammation and endophthalmitis due to P. Acnes. Regarding the surgical approach, both pars plana and corneal routes have been described.