Late-Onset Capsular Bag Distension Syndrome: Complete Visual Recovery Following Pars Plana Posterior Capsulotomy
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT195 | Type: Poster | DOI: 10.82333/k2d6-4007
Authors: Dr Madalina Radu 1 , A/Prof. Calin-Petru Tataru 2 , Dr Crenguta Feraru 3 , Dr Valeriu Rusu 4 , Dr Catalin Cornacel 1 , A/Prof. Mihail Zemba* 5
1Ophthalmology,"Dr. Carol Davila" Central Military Emergency University Hospital,Bucharest,Romania, 2Ophthalmology,University of Medicine and Pharmacy "Carol Davila" ,Bucharest,Romania, 3Ophthalmology,University of Medicine and Pharmacy "Grigore Popa",Iassy,Romania, 4Claris Ophthalmology Center,Iassy,Romania, 5Ophthalmology,University of Medicine and Pharmacy "Carol Davila" ,Bucharest,Romania;Ophthalmology,"Dr. Carol Davila" Central Military Emergency University Hospital,Bucharest,Romania
Purpose
To report a case of late-onset capsular bag distension syndrome (CBDS) presenting with severe visual loss six years after uneventful cataract surgery and to demonstrate the efficacy of pars plana posterior capsulotomy in achieving complete visual recovery.
Setting
Tertiary referral ophthalmology center with vitreoretinal surgical facilities.
Methods
A 72-year-old patient presented with progressive painless visual decline in the right eye over six months, reaching hand motion vision. The patient had undergone uncomplicated phacoemulsification with posterior chamber IOL implantation six years earlier, with postoperative visual acuity of 20/20. Slit-lamp examination showed a well-centered IOL and dense retrolental opacity obscuring the fundus view. Intraocular pressure was 17 mmHg. Anterior segment OCT revealed a dome-shaped fluid collection within the capsular bag, consistent with CBDS. B-scan excluded posterior pathology. A pars plana posterior capsulotomy was performed with evacuation of intracapsular contents and minimal adjacent vitreous removal.
Results
At 7 days postoperatively, uncorrected visual acuity improved from hand motion to 20/20. The anterior segment was quiet with a well-centered IOL and clear visual axis. Fundus examination was normal, and no intraoperative or postoperative complications occurred. The patient reported complete resolution of visual symptoms.
Conclusions
Late-onset CBDS may cause significant visual deterioration years after uncomplicated cataract surgery and can mimic posterior capsule opacification. Anterior segment OCT enables accurate, non-invasive differentiation by demonstrating characteristic intracapsular fluid accumulation. In cases with dense material precluding safe Nd:YAG capsulotomy, pars plana posterior capsulotomy using the vitreous cutter with limited adjacent vitreous removal offers a safe and highly effective treatment approach, enabling controlled material removal and achieving complete visual rehabilitation. Awareness of this rare condition is essential in patients with unexplained late visual decline following cataract surgery.