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Objective: To demonstrate the findings of three consecutive cases of postoperative Capsular Block Syndrome (CBS) diagnosed with the aid of Pentacam virtual eye simulation images. Methods: Observational case series report. Three patients underwent uneventful cataract removal and presented with blurry vision ranging from 4 days to 5 years after the surgeries were performed. Results: In a case of early-onset postoperative CBS, virtual eye simulation images clearly revealed a reduced posterior chamber depth caused by the accumulation of transparent fluid in the area between the intraocular lens and the posterior capsule. In two cases of late-onset postoperative CBS, virtual eye simulation images better visualized the alignment between intraocular lens (IOL) and iris than slit lamp examination and Schiemflug images. All three of the cases underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, and their capsular bag distensions were resolved immediately. The patients with misalignments between IOL and iris experienced more improvement in best-corrected visual acuity as opposed to the one who did not. Conclusion: Virtual eye simulation is found to be a useful way in visualizing misalignment between IOL and iris and assisting diagnoses of both early- and late-onset postoperative capsular block syndrome.

Capsular bag distention syndrome (CBDS) or capsular block syndrome is a rare complication of cataract surgery. Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser usually is effective treatment for CBDS. Rarely, surgical intervention is required in resistant cases (as in our case). Herein, we present the case of a 58-year-old male who presented to us with this condition.

Retro-intraocular lens (IOL) irrigation-aspiration is of paramount importance in order to remove the viscoelastic substance from the retro-IOL space and to prevent any early post-operative capsular block syndrome. However, manoeuvring the IOL to reach the retro-IOL space may be difficult at the hands of novice surgeons despite the use of coaxial or bimanual irrigation-aspiration probes. We describe a simpler and safer technique in order to facilitate the removal of this retro-IOL viscoelastic substance using a 26-Gauge bent-cannula mounted on a 2-ml syringe. The fluid is injected forcefully along with sideways movement of cannula in a single-plane to displace the viscoelastic substance.

Yoichiro Masuda,1 Hisaharu Iwaki,2 Akira Watanabe,3 Akiko Takada,3 Toshinori Okamoto,4 Kotaro Oki,5 Tadashi Nakano,3 Hiroshi Tsuneoka3 1Department of Ophthalmology, The Jikei University, Katsushika Medical Center, Tokyo, Japan; 2Iwaki Eye Clinic, Tokyo, Japan; 3Department of Ophthalmology, The Jikei University, School of Medicine, Tokyo, Japan; 4Nakamurabashi Eye Clinic, Tokyo, Japan; 5Oki Eye Surgery Center, Tokyo, Japan Abstract: Femtosecond laser-assisted cataract surgery (FLACS) changes the intraoperative environment due to the generation of intracapsular gas that induces a high intracapsular volume. Manual hydrodissection (mH) may induce high intracapsular pressure (ICP) and additional intracapsular volume, thereby leading to capsular block syndrome (CBS). Since the phaco-sleeve irrigation-assisted hydrodissection (iH) technique is used to initially groove and split the lens and remove the intracapsular gas, this can reduce the intracapsular volume while bypassing the intracapsular lens prior to the hydrodissection. As iH uses the phaco tip to intentionally vacuum the intraocular fluid for use in inducing the irrigation jet from the sleeve side holes, the ICP cannot surpass the set irrigation pressure, thereby avoiding CBS. Using this technique, we performed FLACS without CBS in 310 cataract eyes. Our findings suggest that the iH technique may be beneficial for patients by preventing CBS during FLACS. Keywords: FLACS, irrigation dynamic pressure, hydrodissection-related complication, capsular block syndrome, CBS, low invasive cataract surgery

Purpose. The goal is to expand the currently known classifications of the capsular block syndrome (CBS) based on the analysis of publications and own experience, taking into account the data of modern research methods. Material and methods. All cases of the capsular block syndrome described in the available scientific literature were analyzed, as well as observations from our own practice with the use of optical coherence tomography of the IOL-capsular bag complex (Optovue). Results. An extended classification of the CBS is based on the classification according the time of onset (intraoperative, early and late postoperative) proposed by Miyake K. et al. (1998). The enlarged classification reflects the possible causes of intraoperative CBS, a variety of clinical and morphological manifestations of CBS in the postoperative period. Conclusion. The proposed classification integrates our own experience and analysis of clinical cases from the literature and can be used for a uniform description of all detected cases of CBS.

(1) Background: We investigated the behavior of gas inside a lens and its influence on the lens capsule, which may cause complications by lens irradiation with a femtosecond laser cataract surgery device. (2) Methods: The crystalline lenses of 6-month-old porcine cadaver eyes were observed during laser irradiation. An intraocular endoscope in the vitreous cavity was used to measure the posterior capsule position. Optical coherence tomography measurements of the anterior chamber depth before and after the laser irradiation, as well as measurements of the equatorial perimeter of the extracted lens, were compared with those of the controls. (3) Results: Femtosecond laser-generated gas in the porcine lens was dependent on laser irradiation energy. Increases in the amount of laser irradiation energy caused the generated gas to coalesce, move backwards beyond the laser irradiation site, and expand the lens capsule and posterior capsule. (4) Conclusions: The present results suggest that laser irradiation-induced gas moves in the direction of the posterior capsule beyond the lens irradiation site and expands the lens capsule, which may be involved in the development of capsular block syndrome.

Aim To analyze and identify the proteomic differences between liquefied after-cataracts and normal lenses by means of liquefied chromatography-tandem mass spectrometry (LC-MS/MS). Methods Three normal lenses and three liquefied after-cataracts were exposed to depolymerizing reagents to extract the total proteins. Protein concentrations were separated using two-dimensional gel electrophoresis (2-DE). The digitized images obtained with a GS-800 scanner were then analyzed with PDQuest7.0 software to detect the differentially-expressed protein spots. These protein spots were cut from the gel using a proteome work spot cutter and subjected to in-gel digestion with trypsin. The digested peptide separation was conducted by LC-MS/MS. Results The 2-DE maps showed that lens proteins were in a pH range of 3-10 with a relative molecular weight of 21-70 kD. The relative molecular weight of the more abundant proteins was localized at 25-50 kD, and the isoelectric points were found to lie between PI 4-9. The maps also showed that the protein level within the liquefied after-cataracts was at 29 points and significantly lower than in normal lenses. The 29 points were identified by LC-MS/MS, and ten of these proteins were identified by mass spectrometry and database queries: beta-crystallin B1, glyceraldehyde-3-phosphate dehydrogenase, carbonyl reductase (NADPH) 1, cDNA FLJ55253, gamma-crystallin D, GAS2-like protein 3, sorbitol dehydrogenase, DNA FLJ60282, phosphoglycerate kinase, and filensin. Conclusion The level of the ten proteins may play an important role in the development of liquefied after-cataracts.

Traditional hydrodissection may cause posterior capsule rupture (PCR) if excessive fluid accumulates. In this study, we describe the successful application of a novel minimal fluid hydrodissection technique in 100 consecutive cataract surgery cases. This technique separates the nucleus from the capsule utilizing low hydrostatic pressure and precise kinetic movement of a small volume (around 0.2 cc) of balanced salt solution. There were no instances of PCR. This technique is suitable for a range of cases, including femtosecond laser-assisted cataract surgery and posterior subcapsular cataract.

The article describes 5 cases of capsular block syndrome (CBS). This late cataract surgery complication has not been sufficiently covered in Russian scientific literature. Diagnostics were based mainly on slit-lamp biomicroscopy and anterior segment optical coherence tomography. In all cases, examination revealed a retro-optical space filled with content of different transparency and homogeneity (transparent liquid, opaque liquid, regenerative lens material). The condition caused visual acuity to decrease in each case. Patient management included follow-ups (2 cases), yttrium-aluminum-garnet laser (YAG-laser) puncture of posterior lens capsule (1 case) or YAG-laser posterior capsulotomy (2 cases). YAG-laser treatment resulted in visual functions improvement.В статье приведено 5 клинических случаев синдрома капсульного блока (СКБ) - позднего послеоперационного осложнения катарактальной хирургии, недостаточно широко представленного в отечественной литературе. Диагноз СКБ основывался на данных биомикроскопической картины и оптической когерентной томографии переднего сегмента глаза. Во всех случаях нами было выявлено пространство между задней поверхностью интраокулярной линзы и задней капсулой хрусталика, не имеющее прямого сообщения с внутриглазной жидкостью, заполненное содержимым различной степени прозрачности и однородности (прозрачная, непрозрачная жидкость, регенераторные элементы хрусталика). Данное состояние приводило к снижению остроты зрения. Тактика ведения пациентов включала наблюдение (2 случая), иттрий-алюминиевый гранат-лазерную (ИАГ-лазерную) пункцию задней капсулы хрусталика (1 случай) или ИАГ-лазерную дисцизию задней капсулы хрусталика (2 случая). После ИАГ-лазерного лечения зрительные функции улучшились.

Yoichiro Masuda,1 Kotaro Oki,2 Hisaharu Iwaki,3 Toshinori Okamoto,1 Hiroshi Tsuneoka4 1Department of Ophthalmology, Jikei University Katsushika Medical Center, 2Oki Eye Surgery Center, 3Iwaki Eye Clinic, 4Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan Abstract: Use of the phaco tip technique for lens cleavage and removal does not require manual hydrodissection using a syringe and cannula, or cortical removal using an irrigation/aspiration tip. The phaco tip is the only surgical instrument required for this technique. Its advantages include maintaining a stable intraocular pressure during cortical cleaving hydrodissection and lens removal, which includes the cortex. Keywords: cataract surgery, hydrodissection, capsular block syndrome, FLACS, Dewey tip

A 54-year-old woman with an epiretinal membrane in her left eye accompanied by a shallow anterior chamber due to primary angle closure glaucoma underwent vitrectomy and cataract surgery. During the cataract surgery, immediately after the ultrasonic tip had been removed from the anterior chamber, anterior chamber flattening occurred. An intraoperative fundus examination showed the development of acute intraoperative choroidal effusion. Postoperatively, the anterior chamber remained shallow even after the choroidal detachment had subsided; capsular bag distension seen by ultrasound biomicroscopy suggested the development of early postoperative capsular block syndrome. After neodymium:yttrium-aluminium-garnet laser capsulotomy, the anterior chamber deepened. Depending on the perioperative period, the mechanism of a flat anterior chamber can change, and understanding the underlying mechanisms is required for appropriate treatment.

A young patient underwent phacoemulsification with endocapsular implantation of trifocal toric lens in both eyes (AT LISA tri toric 939 MP, Carl-Zeiss, Germany). One-week postsurgery, he developed capsular block syndrome (CBS) in both eyes. There was deterioration of uncorrected visual acuity at 1-week postsurgery, with a myopic shift of 2.5 diopters (D) in the right eye and 2.0 D in the left eye. The intraocular pressure was only elevated in the left eye. Neodymium: yttrium-aluminum-garnet laser posterior capsulotomy resolved the block successfully in both eyes. A thick lens with a plate haptic design may have contributed to the early CBS.

To evaluate the effects of irrigation dynamic pressure-assisted hydrodissection (irrigation-hydro: iH) on intraocular pressure (IOP) and the posterior chamber-anterior hyaloid membrane (PC-AHM) barrier in porcine eyes. Experimental. In Experiment 1, IOP was recorded while irrigating the anterior chamber (AC), during iH, and during phacoemulsification and aspiration in 20 porcine eyes using bottle heights of 50, 70, and 90 cm. Under the same conditions, IOP was recorded during conventional manual cortical cleaving hydrodissection (manual hydro: mH) in 20 porcine eyes. In Experiment 2, after iH, ACs were perfused for 5 seconds with balanced salt solution containing 1.0-μm fluorescein beads in 20 porcine eyes using bottle heights of 70, 118, and 169 cm. PC-AHM barrier staining grade was evaluated by the Miyake-Apple view. iH proved successful in all cases. In Experiment 1, IOP during iH was relatively stable and peak IOP was below the baseline bottle height-dependent pressure. No eyes showed a peak IOP > 75 mmHg during iH, but 8 eyes showed a peak IOP > 75 mmHg during mH. In Experiment 2, neither AHT nor ruptured capsules were observed at any bottle height. Unlike mH, IOP during iH was relatively stable without any high peak IOP. Thus, iH offers a simple technique for reducing peak IOP and avoiding disturbance of the PC-AHM barrier.

A 78-year-old man who had phacoemulsification and intraocular lens implantation developed capsular block syndrome (CBS) with secondary glaucoma 18 years after surgery in the affected eye. Ultrasound biomicroscopy (UBM) was used to diagnosis the CBS and evaluate its characteristics. The glaucoma resolved and the intraocular pressure decreased after a neodymium:YAG laser anterior capsulotomy and glaucoma drainage valve implantation. Atypical CBS that is secondary to glaucoma and cannot be diagnosed by a slitlamp examination can be diagnosed using UBM.

Purpose To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of Nd:YAG laser posterior capsulotomy on visual acuity and refractive error as well as its possible complications. Methods In this retrospective cohort study, 12 eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete ophthalmic examination including Scheimpflug camera and anterior segment optical coherence tomography (AS-OCT) imaging had been performed before and after posterior capsulotomy. Results The mean time between cataract surgery and posterior capsulotomy was 4.7 ± 1.5 years (range 3-9 years). Best-corrected visual acuity increased in 11 cases (91.7%). Only one eye showed a 0.5-D hyperopic shift following posterior capsulotomy. There were no postlaser complications such as increased intraocular pressure (IOP), severe inflammation, cystoid macular edema, or retinal detachment. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. The AS-OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the intraocular lens (IOL). Conclusions Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement, or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Furthermore, although AS-OCT measurements are easier to obtain than rotating Scheimpflug imaging examination, both are useful to visualize the distended capsular bag containing the white material and the IOL position.

Capsular block syndrome (CBS) has been known to occur as a rare complication of cataract surgery with continuous curvilinear capsulorhexis and a posterior-chamber lens implant. Typically, it presents with reduced vision in the early postoperative period and is characterised by a forward displacement of the posterior-chamber intra-ocular lens and an accumulation of intra-capsular opaque material. Management of CBS is usually by Nd:YAG laser capsulotomy. In this report, we describe a unique case of very-delayed-onset CBS with good visual acuity, occurring 8 years after surgery. It was treated successfully with surgical removal of the opaque material.

Purpose To study the characteristics of late-onset capsular block syndrome (CBS) using swept-source anterior segment optical coherence tomography (AS-OCT) and assess morphometric variations after treatment with neodymium:YAG (Nd:YAG) laser posterior capsulotomy. Setting Ophthalmology, University of Parma, Parma, Italy. Design Case series. Methods Patients with late-onset CBS had an ophthalmology evaluation, including slitlamp photography and AS-OCT, before and 1 month after ND:YAG laser posterior capsulotomy. The diameter of the anterior capsulorhexis, the posterior displacement of the posterior capsule, and the anterior chamber depth (ACD) were measured using AS-OCT. Measurements before and after Nd:YAG laser posterior capsulotomy were compared using the paired t test. Results The study evaluated 6 patients. Slitlamp examination showed accumulation between the intraocular lens (IOL) and the posterior capsule of milky-white or particulate liquefied material that appeared hyperreflective on AS-OCT and caused posterior displacement of the posterior capsule (mean 1.38 mm). The diameter of the anterior capsulorhexis (mean 4.5 mm) was smaller than the IOL optic in all cases. After uneventful Nd:YAG laser posterior capsulotomy, the corrected distance visual acuity improved in all patients ( P P =.15 and P =.36, respectively). Conclusions Anterior segment OCT allowed accurate imaging and measurement of anterior segment parameters in late-onset CBS. No displacement of the IOL was found after treatment with Nd:YAG laser posterior capsulotomy. Neodymium:YAG laser posterior capsulotomy was an effective and safe therapy in the 6 late-onset CBS cases. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

A 78-year-old man had uneventful cataract surgery with implantation of a 1-piece plate–haptic intraocular lens in the capsular bag. Seven weeks later, he presented as an emergency with intense fibrinous uveitis and increased intraocular pressure (IOP). Examination revealed an inflammatory capsular block syndrome (CBS) causing fibrinous anterior uveitis and secondary angle-closure glaucoma. The glaucoma resolved and the patient’s vision improved following neodymium:YAG laser posterior capsulotomy. Inflammatory CBS should be considered in pseudophakic patients presenting with fibrinous anterior uveitis, increased IOP, and secondary angle closure. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Yoichiro Masuda,1 Hisaharu Iwaki,2 Noriko Kato,1 Genichiro Takahashi,1 Kotaro Oki,3 Hiroshi Tsuneoka4 1Department of Ophthalmology, The Jikei University, Katsushika Medical Center, 2Iwaki Eye Clinic, 3Oki Eye Surgery Center, 4Department of Ophthalmology, The Jikei University, School of Medicine, Tokyo, Japan Abstract: The irrigation dynamic pressure-assisted hydrodissection technique (irrigation-hydro [iH]) does not require performing manual hydrodissection using a syringe and cannula to achieve cortical-capsular cleavage during cataract surgery. Since the iH technique uses the phaco tip to intentionally vacuum the intraocular fluid in order to induce the irrigation dynamic pressure for cortical-capsular cleavage, there is a reduction in the intraocular pressure (IOP) from the bottle-height-dependent hydrostatic pressure. Thus, since the peak irrigation pressure derived from the phaco tip sleeve will be limited by the height of the irrigation fluid bottle, this is advantageous in helping to avoid excessively high IOP during cortical-capsular hydrodissection. Using this technique, we were able to effectively perform phacoemulsification without complications in 607 of 609 cataract eyes. Our findings show that utilization of the iH technique would be of benefit to patients, as it prevents high-pressure hydrodissection-related complications, such as capsular block syndrome and tears in the anterior hyaloid membrane during cataract surgery. Keywords: cataract surgery, hydrodissection, irrigation pressure, hydrodissection-related complication, capsular block syndrome, anterior hyaloid membrane tear, FLACS

We describe 2 patients with late capsular block syndrome whose anterior chamber morphology was evaluated with ultrasound biomicroscopy and Scheimpflug imaging before and after neodymium:YAG laser capsulotomy. Pretreatment ultrasound biomicroscopy examination showed significant capsular bag distension in both patients. Scheimpflug imaging failed to capture the posterior capsule displaced far behind the intraocular lens. Automatic anterior chamber depth measurements were incorrect with Scheimpflug imaging in 1 patient. Ultrasound biomicroscopy seems to be superior to Scheimpflug imaging in eyes with extremely distended capsular bags. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Background Capsular block syndrome is an uncommon complication that occurs after cataract surgery. It is characterized by capsular distension, anterior intraocular lens displacement, anterior chamber shallowing, and unexpected myopic shifts. We report a case of recurrent fibrotic capsular block syndrome with Elschnig’s pearl-type posterior capsule opacification 10 months after neodymium-yttrium-aluminum-garnet (Nd:YAG) laser anterior capsulotomy. Case presentation A 72-year-old Asian man complained of decreased visual acuity 5 years after undergoing phacoemulsification with posterior chamber lens implantation. Under slit-lamp examination, late postoperative capsular block syndrome was diagnosed and Nd:YAG laser anterior capsulotomy was performed. Ten months after anterior capsulotomy, the patient returned with decreased visual acuity and was diagnosed with recurrent fibrotic capsular block syndrome. Nd:YAG laser posterior capsulotomy was performed. Conclusions We found that fibrotic capsular block syndrome could recur with Elschnig’s pearl-type posterior capsule opacification after Nd:YAG laser anterior capsulotomy for late postoperative capsular block syndrome without posterior capsule opacification.

Capsular bag distension syndrome is a very rare complication of cataract surgery. Most cases occur after uneventful phacoemulsification with continuous curvilinear capsulorhexis and implantation of an intraocular lens in the capsular bag. The entity presents with reduction of visual acuity and myopic shift in the early-to-late postoperative period. Characteristic findings include the distension of the capsular bag due to the accumulation of milky material and the forward displacement of the intraocular lens. We present two cases with an unusually delayed presentation of 6 and 8 years respectively following phacoemulsification, and describe their successful management with Nd:YAG laser posterior capsulotomy.

We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

A 57-year-old male patient visited our clinic for decreased visual acuity in the right eye for 10 days. He denied any trauma history, but recalled that the symptom developed after straining. He had undergone uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation in the bag of the right eye 11 years ago. The IOL was a three-piece silicone polyimide-haptics design. On slit-lamp examination, the IOL optic and proximal part of nasal fractured haptic were found in the anterior chamber. The distal part of fractured haptic was observed in the capsular bag. He underwent IOL exchange. The fracture site of the haptic was near the optic-haptic junction. This is the unique case report of a spontaneous fracture of an implanted posterior chamber polyimide IOL haptic, which implies the possibility of IOL haptic fracture in various haptic materials.

Hintergrund: Im Anschluss an eine Kataraktoperation kann es durch nicht vollstandig entferntes Viskoleastikum zu einem Hydrops des Kapselsacks kommen. In dieser retrospektiven Fallserie werden die postoperative Kapselsackdehnung und deren Folgen nach Implantation faltbarer Acryllinsen in den Kapselsack beschrieben. Patienten und Methode: In einer retrospektiven Analyse von Krankengeschichten wurden von insgesamt 1674 kataraktoperierten Augen im Zeitraum Januar 2001 bis Dezember 2002 10 Augen mit fruhpostoperativem Kapselblocksyndrom identifiziert. Bei allen Augen erfolgten eine kurvolineare Kapsulorhexis, Phakoemulsifikation der Linse und Implantation einer faltbaren Acryllinse in den Kapselsack. Bei 4 von 10 Augen wurde die Kataraktextraktion mit einer Trabekulektomie kombiniert. Postoperativ erfolgten engmaschige Kontrollen. Bei allen Patienten wurde nach vorgangiger Bestimmung der Refraktion eine hintere Kapsulotomie mit dem Nd:YAG-Laser durchgefuhrt und die Refraktionsanderung festgehalten. Resultate: Die postoperativen Untersuchungen zeigten eine Dehnung des Kapselsacks bei allen Patienten. Die mittlere postoperative Refraktion betrug - 3,9 ± 1,6 dpt, was gegenuber der Zielrefraktion (- 1,2 ± 1,0 dpt) einer Myopisierung von durchschnittlich - 2,7 ± 1,4 dpt entspricht. Ein vermehrter postoperativer Reizzustand wurde nur bei einem Patienten und eine Abflachung der Vorderkammer bei einem weiteren Patienten beobachtet. Durch die im Schnitt 4,5 ± 4,3 Monate postoperativ durchgefuhrte Nd:YAG-Kapsulotomie kam es zu einem Kollaps des Kapselsacks mit einer mittleren Abnahme der Kurzsichtigkeit von 1,9 dpt ± 1,9 dpt. Schlussfolgerungen: Die ungewollte Myopisierung wurde in dieser Serie als weit gehend einzige Manifestation des fruhpostoperativen Kapselblocksyndroms beobachtet. Auffallig ist der hohe Anteil von kombiniert katarakt- und glaukomoperierten Augen. Dies hangt womoglich mit der intraoperativen Gabe von Miotika vor der Spulphase zusammen, die die optische Kontrolle wahrend der Entfernung des Viskoelastikums erschweren. Bei ungewollter Myopisierung nach Kataraktoperation sollte die Lage der Linse im Kapselsack gepruft und nach verbliebenem Viskoelastikum gesucht werden. Background: Incomplete removal of the viscoelastic material during cataract surgery may lead to the early postoperative capsular block syndrome. In this retrospective case series, postoperative capsular bag distention after implantation of a foldable acrylic lens is reported and the sequelae are analyzed. Patients and method: In a retrospective case series, 10 eyes of altogether 1674 eyes that underwent cataract surgery in the years 2001 and 2002 were identified with early postoperative capsular block syndrome. All 10 eyes had cataract removal with continuous curvilinear capsulorhexis, phacoemulsification and a foldable acrylic lens was placed in the capsular bag. In 4 of 10 eyes cataract extraction was combined with trabeculectomy. All patients had posterior Nd:YAG capsulotomy. Refraction was performed before and after capsulotomy. Results: Postoperative examination showed capsular bag distention in all eyes. The mean postoperative spherical equivalent was -3.9 ± 1.6 Dpt. As the target refraction was -1.2 ± 1.0 Dpt there was an average of -2.7 ± 1.4 Dpt of induced myopia. A mild increase in postoperative anterior chamber inflammation was noted only in 1 patient and shallowing of the anterior chamber was observed in another patient. Posterior Nd:YAG capsulotomy was performed 4.5 ± 4.3 months after surgery. The mean refractive shift after Nd:YAG capsulotomy was 1.9 ± 1.9 Dpt. Conclusions: Unexpected postoperative myopic correction was the main manifestation of capsular block syndrome in this series. Intraoperative use of miotics prohibiting optical control of complete viscoelastic removal may explain the high proportion of combined procedures. In the case of unexpected postoperative myopia the position of the intraocular lens within the bag should be checked and attention should be paid to possibly incompletely removed viscoelastic material.

Annular elastolytic giant cell granuloma is a condition characterized histologically by damaged elastic fibers associated with preponderance of giant cells along with absence of necrobiosis, lipid, mucin, and pallisading granuloma. It usually occurs on sun-damaged skin and hence the previous name actinic granuloma. A similar process occurs on the conjunctiva. Over the past three decades only four cases of conjunctival actinic granuloma have been documented. All the previous patients were females with lesions in nasal or temporal bulbar conjunctiva varying 2-3 mm in size. We report a male patient aged 70 years presenting with a 14 mm × 7 mm fleshy mass on right lower bulbar conjunctiva. Clinical differential diagnoses were lymphoma, squamous cell carcinoma in situ and amyloidosis. Surgical excision followed by histopathology confirmed it to be a case of actinic granuloma. This is the first case of isolated conjunctival actinic granuloma of such a large size reported from India.

Purpose To analyze the transparent liquid between the posterior lens capsule and the posterior chamber intraocular lens (PC IOL) in early postoperative capsular block syndrome and discuss the mechanism of posterior capsule distention. Setting Department of Ophthalmology, Tokyo University School of Medicine, and Tokyo Research Institute, Seikagaku Corporation, Tokyo, Japan. Methods This study evaluated 3 cases of capsular block syndrome presenting with transparent liquid in the distended capsular bag 1 day after cataract surgery. The transparent liquid material between the posterior capsule and PC IOL was aspirated and analyzed using high-performance liquid chromatography (HPLC). Also, sodium hyaluronate was diluted using a dialyzer to determine whether the aqueous humor was drawn into the capsular bag by an osmotic gradient across the capsule. Results The elution time of the samples was almost the same as that of sodium hyaluronate 1.0% (Healon®) The concentration of the samples ranged from 3.29 to 9.01 mg/mL by HPLC analysis. The sodium hyaluronate absorbed the physiological salt solutions through the dialyzer and expanded to 1.9 times its original volume. Conclusions These results indicate that the main ingredient of the transparent liquid in capsular bags is sodium hyaluronate and that the distention is caused by aqueous humor being drawn into the capsular bag by an osmotic gradient across the capsule when the capsulorhexis diameter is smaller than that of the PC IOL and by viscoelastic material retained and trapped in the bag intraoperatively.

Capsular block syndrome (CBS) is a complication of uncomplicated cataract surgery. Depending on etiology and the time of onset CBS can be subdivide into three types. The cases of 4 patients with CBS type III who presented with a milky fluid in the space between the posterior surface of the implanted intraocular lens (IOL) and the anterior surface of the distended posterior capsular bag are described. All patients complained of reduced vision. The therapy of choice is Nd:YAG laser posterior capsulotomy but with suspected low-grade endophthalmitis surgical intervention can also be carried out and submitting the plug for bacterial culture.

tions, as noted in previous studies, 9 in the fifth and sixth decades of life. Since this is a general phenomenon, we should see these changes in the long-term follow-up of non-RK corneal refractive procedures. It is hypothesized that these changes are due to agerelated progressive changes in ciliary muscle tone. 11 Therefore, one unavoidable conclusion would be that refractive surgery that replaces the crystalline lens could uniquely avoid this variable and unpredictable phenomenon. If loss of ciliary tonicity causes a net loss in the dioptic power of the crystalline lens due to a change in the lens shape, one would expect that simply replacing the crystalline lens with a conventional intraocular lens (IOL) would prevent this hyperopic shift. However, if the change in tonicity is associated with a positional change of the crystalline lens, the hyperopic shift would persist even with the lens exchange and an adjustable IOL would be required for refractive stability. 12

Purpose: To propose a new classification of capsular block syndrome (CBS) to improve understanding of the etiology and provide effective treatment. Setting: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, and Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan. Methods: Three groups of eyes with CBS were reviewed: eyes originally reported and diagnosed as having CBS; eyes experiencing CBS after hydrodissection and luxation of the lens nucleus; and eyes with CBS accompanying liquefied aftercataract or capsulorhexis-related lacteocrumenasia. Results: In all 3 groups, the CBS occurred in eyes with a -continuous curvilinear capsulorhexis (CCC). It was characterized by accumulation of a liquefied substance within a closed chamber inside the capsular bag, formed because the lens nucleus or the posterior chamber intraocular lens (IOL) optic occluded the anterior capsular opening created by the CCC. Depending on the time of onset, CBS can be classified as intraoperative (CBS seen at the time of lens luxation following hydrodissection), early postoperative (original CBS), and late postoperative (CBS with liquefied aftercataract or lacteocrumenasia). The etiology of the accumulated substance and the method of treatment are different in each type. Conclusion: Capsular block syndrome is a complication of cataract/10L surgery that can occur during and after surgery. Correctly identifying the type of CBS is crucial to understanding the nature and effective treatment of this disorder.

We report a case of late postoperative capsular block syndrome presenting with a hyperopic shift and discuss possible causes of this unusual presentation.

Two cases of late capsular block syndrome are reported. They were observed nine and five years after facoemulsification, in one eye with pseudoexfoliation syndrome and the other operated on for glaucoma with a functioning bleb. There was a large amount of milky material behind the intraocular lens, and reduction of the visual acuity (four lines of the Snellen chart in both cases). The condition was promptly resolved through minimal YAG laser posterior capsulotomy.

Three patients who presented with a milky fluid in the space between the posterior surface of an implanted intraocular lens (IOL) and the anterior surface of the distended posterior capsular bag are described. The patients were followed and were noted to have changes in their benign course after several years. The occurrence of this milky-fluid-filled capsular bag is extremely uncommon and is difficult to perceive if the observer is not looking for it.

We report a case of capsular bend-related entrapment of liquefied after-cataract that resulted in late postoperative capsular block syndrome in a 56-year-old man. Slitlamp examination showed a capsular bend formation at the square edge of the optic. Superiorly, leakage in the capsular bend resulted in fluid extending into Soemmering's ring, although communication with the anterior chamber was limited by the capsular bend. Fluid was seen between the lens and posterior capsule.

A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C 3 F 8 gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C 3 F 8 gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.

This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

A 59-year-old woman developed progressive, moderate myopia 1 year after routine phacoemulsification and insertion of a soft posterior chamber intraocular lens (IOL). After biomicroscopy, late capsular block was diagnosed and treated with a neodymium:YAG laser posterior capsulotomy. The myopia disappeared immediately. This case was illustrated using optical coherence tomography developed for the anterior segment. After capsulotomy, the IOL moved backward by 448 μm, corresponding to –0.75 diopter of induced myopia.

Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months follow-up after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.

We describe two patients with late-onset capsular block syndrome who presented 6 years and 4 years, respectively, after cataract surgery and were successfully treated with Nd:YAG capsulotomy.

Seven cases of capsular bag distension following capsulorhexis and phacoemulsification with posterior chamber intraocular lens insertion are presented. The proposed physiological mechanism, associated consequences, and complications and treatment are presented.

We report the case of a 76-year-old Chinese man who had uneventful cataract phacoemulsification and hydrophilic acrylic intraocular lens (IOL) implantation 6 years previously. He presented with decreased vision; a homogeneous milky substance was found between the posterior chamber IOL and the posterior capsule without IOL displacement or a change in the refractive status. The milky substance was aspirated from the capsular bag. Biochemical analysis showed the concentrations of proteins and Ca(++) in the milky liquid were higher than those in the aqueous humor. Protein identification by mass spectrometry indicated that the milky liquid contained a high concentration of alpha-crystallin and beta-crystallin.