AS-OCT DIAGNOSIS OF LATE-ONSET CAPSULAR DISTENSION SYNDROME SEVEN YEARS AFTER CATARACT SURGERY

To report a late-onset case of capsular bag distension syndrome seven years after uncomplicated cataract surgery.

Department of Ophthalmology, Diskapi Yildirim Beyazit Training and Education Hospital, Ankara, Türkiye.

A 69-year-old woman presented to our clinic with a yellowish hue to vision in her right eye. The patient had undergone uncomplicated phacoemulsification with intraocular lens (IOL) implantation in the same eye seven years previously and had no visual complaints until two weeks prior to presentation. She had no history of diabetes mellitus or systemic medication use, except for vitamin D supplementation due to osteoporosis. Autorefraction was −0.50 −0.50×90 in the right eye (OD) and +2.00 −1.25×90 in the left eye (OS). Best-corrected visual acuity (BCVA) was 20/20 bilaterally. Intraocular pressure (IOP) measured with non-contact tonometry was 13 mmHg in OD and 15 mmHg in OS. Slit-lamp biomicroscopy revealed a clear cornea and a well-centered posterior chamber IOL in the right eye. The capsulorhexis measured approximately 5.5 mm. A turbid, milky opacity was observed between the IOL and the posterior capsule, along with temporal anterior capsular fibrosis adherent to the IOL and white fibrous material in the inferior capsular bag (Fig 1). The left eye showed only nuclear sclerosis and was otherwise unremarkable. Anterior segment optical coherence tomography (AS-OCT, RTVue-XR, Optovue Inc., Fremont, CA) was performed for differential diagnosis of posterior chamber opacification. AS-OCT demonstrated a transparent IOL and accumulation of milky, liquefied material between the posterior capsule and IOL (Fig 2). Based on these findings, the patient was diagnosed with late-onset capsular bag distension syndrome (CBDS). Because visual acuity remained unaffected and symptoms were mild, Nd:YAG anterior and/or posterior capsulotomy was recommended; however, the patient elected observation and short-term follow-up.

Postoperative CBDS may occur due to residual viscoelastic material, retained cortical remnants, postoperative inflammation, small capsulorhexis size, or IOL design. In rare cases, sequestration of Cutibacterium (Propionibacterium) acnes within the capsular bag has been implicated. The main goal of treatment is to release the turbid fluid trapped between the posterior capsule and the IOL. Nd:YAG anterior or posterior capsulotomy is an effective and commonly preferred therapeutic approach. AS-OCT is particularly valuable for distinguishing CBDS from other postoperative opacifications, including IOL glistening or posterior capsular opacification, and should be considered in the diagnostic evaluation of pseudophakic patients presenting with unusual visual symptoms.