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Introduction: We present a case of capsular block syndrome that occurred after intravitreal injection of ranibizumab in a patient with age-related macular degeneration, which has not been reported in the literature. Case Presentation: A 78-year-old male presented with decreased visual acuity in the right eye. Slit-lamp examination findings were unremarkable; however, AMD was diagnosed based on fundus examination, fluorescein angiography, and optical coherence tomography (OCT). Subsequently, the patient was administered an intravitreal injection of ranibizumab. A slit-lamp examination revealed residual cortical material, numerous inflammatory cells, and posterior capsular distension 1 week after the injection. OCT showed an adhesion of the intraocular lens to the continuous curvilinear capsulorhexis site. The patient’s vision improved following Nd:YAG laser posterior capsulotomy. Conclusion: Meticulous cortical removal is crucial during phacoemulsification to prevent capsular block syndrome. In patients with a history of cataract surgery, verifying the absence of residual cortical material before administering an intravitreal injection of ranibizumab is important.

We report a case of late Capsular Block Syndrome (CBS) in a patient who underwent cataract surgery 12 years back. It was diagnosed with slit-lamp examination and by using anterior segment optical coherence tomography (AS-OCT) that showed hyper-reflective material trapped in the capsular bag, between the IOL posterior surface and the posterior capsule. Anterior capsule fibrosis was seen in both eyes but in the left eye capsulorhexis showed irregular margins and had a smaller diameter compared to the right eye. The CBS was treated with Nd: YAG laser capsulotomy allowing rapid evacuation of liquid towards the vitreous chamber. Complete resolution of CBS was confirmed by AS-OCT. Best Corrected Visual Acuity (BCVA) of left eye improved from 0.2 logMAR before treatment to 0.0 logMAR one week after treatment. BCVA remained unchanged after one year of follow-up with no sign of new posterior capsular fibrosis. [ABSTRACT FROM AUTHOR]

Introduction: Pseudophakic pupillary block angle-closure glaucoma is an uncommon complication following uneventful cataract surgery with posterior chamber intraocular lens (IOL) implantation. Interestingly, capsular block syndrome (CBS) has been reported as another plausible cause of pseudophakic pupillary block angle-closure glaucoma, especially in the early postoperative period. Unlike early postoperative CBS, late postoperative CBS is not associated with a shallow anterior chamber, myopic shift, or elevated intraocular pressure. We report a case of late postoperative CBS presenting with an acute-onset pupillary block angle-closure attack occurring 13 years after uneventful cataract surgery with posterior chamber IOL implantation, which has not been reported in the literature. Case Presentation: An 87-year-old male diagnosed with pseudoexfoliation syndrome developed pseudophakic pupillary block following uneventful cataract surgery with posterior chamber IOL implantation. Late-onset CBS has been identified as the underlying cause of the pupillary block. The combination of zonular laxity observed in pseudoexfoliation syndrome and the presence of a Soemmering ring are potential predisposing factors for this condition. After performing laser peripheral iridotomy (LPI) followed by Nd: YAG capsulotomy, the pupillary block was resolved and vision was improved. Conclusion: CBS should be considered as a potential cause of pseudophakic pupillary block, even in the late postoperative period. The management of late-onset CBS accompanied by pupillary block angle-closure glaucoma typically includes LPI to eliminate the pupillary block, followed by Nd: YAG capsulotomy.

Introduction: Lacteocrumenasia is a relatively rare postoperative complication of cataract surgery. It is classified as a late-onset type of capsular block syndrome (CBS) and is often accompanied by myopia; however, its mechanism is not clearly understood. Case Presentation: We report a case of a 62-year-old male patient having CBS with myopia. The patient was treated with neodymium-yttrium aluminum garnet (Nd-YAG) laser posterior capsulotomy. We measured and compared the depth of the intraocular lens using anterior segment optical coherence tomography (AS-OCT) before and after laser treatment. Treatment resulted in refraction improvement of more than 1.0 diopters. The intraocular lens depth before and after Nd-YAG laser irradiation had very mild changes of less than 0.05 mm, which did not explain the refractive changes. Conclusion: Myopia in the early-onset type of CBS is caused by anterior deviation of the intraocular lens; however, the evaluation of this case using AS-OCT suggested that an abnormal intraocular lens position may not be involved in late-onset CBS.

Introduction: We present a case of capsular block syndrome that occurred after intravitreal injection of ranibizumab in a patient with age-related macular degeneration, which has not been reported in the literature. Case Presentation: A 78-year-old male presented with decreased visual acuity in the right eye. Slit-lamp examination findings were unremarkable; however, AMD was diagnosed based on fundus examination, fluorescein angiography, and optical coherence tomography (OCT). Subsequently, the patient was administered an intravitreal injection of ranibizumab. A slit-lamp examination revealed residual cortical material, numerous inflammatory cells, and posterior capsular distension 1 week after the injection. OCT showed an adhesion of the intraocular lens to the continuous curvilinear capsulorhexis site. The patient's vision improved following Nd:YAG laser posterior capsulotomy. Conclusion: Meticulous cortical removal is crucial during phacoemulsification to prevent capsular block syndrome. In patients with a history of cataract surgery, verifying the absence of residual cortical material before administering an intravitreal injection of ranibizumab is important. [ABSTRACT FROM AUTHOR]

Introduction: Pseudophakic pupillary block angle-closure glaucoma is an uncommon complication following uneventful cataract surgery with posterior chamber intraocular lens (IOL) implantation. Interestingly, capsular block syndrome (CBS) has been reported as another plausible cause of pseudophakic pupillary block angle-closure glaucoma, especially in the early postoperative period. Unlike early postoperative CBS, late postoperative CBS is not associated with a shallow anterior chamber, myopic shift, or elevated intraocular pressure. We report a case of late postoperative CBS presenting with an acute-onset pupillary block angle-closure attack occurring 13 years after uneventful cataract surgery with posterior chamber IOL implantation, which has not been reported in the literature. Case Presentation: An 87-year-old male diagnosed with pseudoexfoliation syndrome developed pseudophakic pupillary block following uneventful cataract surgery with posterior chamber IOL implantation. Late-onset CBS has been identified as the underlying cause of the pupillary block. The combination of zonular laxity observed in pseudoexfoliation syndrome and the presence of a Soemmering ring are potential predisposing factors for this condition. After performing laser peripheral iridotomy (LPI) followed by Nd: YAG capsulotomy, the pupillary block was resolved and vision was improved. Conclusion: CBS should be considered as a potential cause of pseudophakic pupillary block, even in the late postoperative period. The management of late-onset CBS accompanied by pupillary block angle-closure glaucoma typically includes LPI to eliminate the pupillary block, followed by Nd: YAG capsulotomy. [ABSTRACT FROM AUTHOR]

Introduction: Lacteocrumenasia is a relatively rare postoperative complication of cataract surgery. It is classified as a late-onset type of capsular block syndrome (CBS) and is often accompanied by myopia; however, its mechanism is not clearly understood. Case Presentation: We report a case of a 62-year-old male patient having CBS with myopia. The patient was treated with neodymium-yttrium aluminum garnet (Nd-YAG) laser posterior capsulotomy. We measured and compared the depth of the intraocular lens using anterior segment optical coherence tomography (AS-OCT) before and after laser treatment. Treatment resulted in refraction improvement of more than 1.0 diopters. The intraocular lens depth before and after Nd-YAG laser irradiation had very mild changes of less than 0.05 mm, which did not explain the refractive changes. Conclusion: Myopia in the early-onset type of CBS is caused by anterior deviation of the intraocular lens; however, the evaluation of this case using AS-OCT suggested that an abnormal intraocular lens position may not be involved in late-onset CBS. [ABSTRACT FROM AUTHOR]

We present a novel use of femtosecond laser to treat capsular block syndrome (CBS) in a patient with dense opaque capsular block, who presented 16 years postcataract surgery. The extensive posterior capsular distension and densely opaque, milky fluid trapped behind the intraocular lens (IOL) prevented the use of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser posterior capsulotomy as primary treatment. Intra-operative optical coherence tomography enabled visualization of the posterior capsule and iris hooks were used to increase the pupillary diameter to enable femtosecond laser-assisted posterior capsulotomy to be performed in a minimally invasive technique. CBS was relieved successfully and Nd: YAG laser performed subsequently to remove residual posterior capsule opacification safely and with good visual outcomes. This method avoids risks associated with posterior vitrectomies and compromised IOL stability from inadvertent capsular bag damage, and adds to the expanding uses of femtosecond laser technology.

Purpose: To report our findings in a case that had an accumulation of a translucent fluid between the intraocular lens (IOL) and posterior lens capsule one day after vitrectomy for a vitreous hemorrhage. Observations: A 67-year-old woman was diagnosed with diabetes 20 years before the vitrectomy and was treated with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) 14 years earlier. She underwent cataract surgery with an implantation of an IOL 4 years earlier. She was referred to our hospital because of a vitreous hemorrhage, and we performed uneventful vitrectomy. However, the day after the operation, a translucent liquid substance that resembled liquefied aftercataract was observed in the lens capsule bag. With time, the liquid substance became cloudy. The opacification progressed for two years after the vitrectomy, and her visual acuity decreased. We then performed neodymium: YAG (Nd: YAG) laser posterior capsulotomy, and the cloudy liquid dispersed into the vitreous and the visual acuity improved. Conclusions and importance: Our findings indicate that liquified aftercataract-like substance can form after vitrectomy in a pseudophakic eye. We suggest that the aqueous humor might flow into the space behind the IOL during or just after the vitrectomy and was trapped behind the IOL optics. Then, the proliferating lens epithelial cells might be dissolved forming the white liquid substance immediately after the surgery.

(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. [ABSTRACT FROM AUTHOR]

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.

Introduction:Postoperative capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery which might occur in the early postoperative period, as well as several years after uncomplicated surgery. The aim of this study was to review the current evidence on postoperative capsular bag distension syndrome. Material and Methods: PubMed and Web of Science were used for literature search. Results: The typical presentation involves deterioration in visual acuity, unexpected myopic shift or less frequently hyperopia. In eyes with clear capsular fluid and no posterior capsule opacification, usually in the late postoperative period, CBDS can be asymptomatic. Risk factors for developing CBDS include retained ophthalmic viscoelastic device, inadequate subincisional cortex cleaning, apposition between the intraocular lens (IOL) and the capsular bag, postoperative inflammation and IOL sequestration with Propionibacterium acnes. Visualization of the CBDS can be aided with Scheimpflug imaging, ultrasound biomicroscopy, and particularly anterior-segment optical coherence tomography. Conclusion:Nd:YAG posterior capsulotomy, and in some cases anterior capsulotomy, is accepted as a standard and effective CBDS treatment. Surgical approach could be beneficial in cases suspected of Propionibacterium acnes presence or when it is impossible to perform Nd:YAG posterior capsulotomy. [ABSTRACT FROM AUTHOR]

Purpose: 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.Study design: Experimental.Methods: 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.Results: 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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

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

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.

Capsular block syndrome as a complication after phacoemulsification and posterior chamber intraocular lens (IOL) implantation when the capsular bag is distended by an accumulation of particular substance between the optical surface of the IOL and the posterior capsule has been not widely highlighted in the national scientific literature. The article presents a review of publications of foreign authors describing this phenomenon, its etiology, classification and methods of treatment.

Purpose. To estimate the number and type of complications during the femtosecond laser assisted cataract surgery and to develop methods of decreasing them.Material and methods. The operation was performed in the period from October 2012 to August 2014. The study included 815 patients (1239 eyes). The mean age was 69.1±6.1 years (M±m). The femtosecond laser assisted step was realized using the Victus femtolaser, Valeant Co. (USA). Cataract phacoemulsification was carried out by standard techniques by means of the Stellaris device of Valeant Company,USA.Results. Complications associated with the femtosecond laser cuts: corneal femto cuts depressurization during the transition of the patient from one operating room to another – 0%, during phacoemulsification cataract surgery: detachment of Descemet’s membrane in the paracentesis – 2 (0.2%), in the main section – 9 (0.7%), thermal burns in the main section – 3 (with the nucleus density: grade 4+ cataract) (0.2%). Postoperative hypotension – 3 (0.2%) in the combined intervention with glaucoma surgery. Milling or absence of the anterior chamber of 0%. During the anterior capsulotomy 1133 (91%) a floating track, 101 (8%) clued fragment with a complete capsulotomy, radial gaps of capsulotomy 0%. 3 (0.2%) as a result of lens subluxation starting the technique mastering. There were 5 cases (0.4%) of capsulotomy forming 3 bridges (0.2%). Loss of vacuum occurred in 3 cases. Intraand postoperative IOP elevation was not significant. Capsular blockage – 0%. Posterior capsular tear – 2 (0.2%). Choroidal detachment – 18 (1.5%), iridocyclitis – 19 (1.5%). There was no case of endophthalmitis (0%), hyphema (0%), nuclear or lens fragments dislocation into vitreous cavity (0%). The macular area of the retina showed no significant thickening.Conclusion. 1. It is important to use an NSAID drugs and individual mydriatics groups already one day before the surgery to prevent the narrowing of the pupil in response to the femtosecond laser impact. 2. Exclusion too restless patients with very narrow eyelid margin and deep-set eye. We also recommend to cancel the femtosecond laser step when mydriasis is less than 5mm. 3. Prevention of formation of capsular block syndrome using intra-operative release of gas bubbles before the hydrodissection or its exception.

Purpose: To evaluate patients prediagnosed with capsular block syndrome (CBS) using slit-lamp adapted anterior segment optical coherence tomography (SL-OCT) prospectively. Materials and Methods: The eyes of the patients with decreased vision following phacoemulsification and intraocular lens (IOL) implantation prediagnosed as capsular block syndrome were included. Following ophthalmological examination with pupillary dilation, SL-OCT imaging was performed. Results: The study included 17 eyes of 17 cases with late onset CBS. The mean period of time between cataract operation and CBS diagnosis was 66.5± 31.6 months (range 5 to 120 months). The interspace between posterior surface of the IOL and posterior capsule was hyporeflective in six cases and hyperreflective in other cases. The mean posterior displacement of posterior capsule was 1.02 ± 0.74 mm (ran ge 0.35 to 2.17 mm) at the deepest location. Except for three cases all were treated with Neodymium:YAG (Nd:Y AG) laser posterior capsulotomy. Conclusion: Late-onset CBS can be seen years after phacoemulsification surgery and is thought to be occurred by the liquefied retained cortical material. Also, this condition may be misdiagnosed as IOL opacification. SL-OCT is a useful and supportive method in the demonstration and differential diagnosis of CBS. [ABSTRACT FROM AUTHOR]

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.

AIM: To evaluate the clinical outcomes of Nd:YAG laser capsulotomy in the treatment of early stage capsular block syndrome(CBS). METHODS: Eighteen patients(21 eyes)with early stage capsular block syndrome were treated using Nd:YAG laser by anterior capsulotomy only or combined with posterior capsulotomy from January 2010 to July 2015 in Anyang Eye Hospital. Uncorrected distance visual acuity, intraocular pressure, spherical equivalent, depth of anterior chamber were observed preoperatively and 2wk postoperatively. RESULTS: Seventeen eyes simply underwent peripheral anterior capsulotomy with Nd: YAG laser. Four eyes were combined with posterior capsulotomy. Compared with preoperative, uncorrected distance visual acuity improved, intraocular pressure returned to normal, degree of myopia reduced, depth of anterior chamber had deepened. CONCLUSION: Nd:YAG laser capsulotomy is an effective treatment for early stage capsular block syndrome.

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.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28-day-old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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.

While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infections have been reported in immunocompetent individuals. The purpose is to report an eye with post-operative Aspergillus endophthalmitis, which achieved a good visual outcome following early and aggressive treatment. A young patient, known case of allergic bronchopulmonary aspergillosis presented to us with post-cataract surgery endophthalmitis. He was treated with pars plana vitrectomy and intravitreal voriconazole and systemic itraconazole. The patient regained a vision of 20/30 with follow up of 2 years.

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.

We are reporting an interesting case of ichthyosis follicularis with alopecia and photophobia syndrome in a daughter and father from the Indian subcontinent associated with Meibomian gland dysfunction. A three-year-old female child presented with pain, redness and severe photophobia in both eyes since one month. Cutaneous examination revealed ichthyosis, absence of hair all over the body including eyebrows, scalp and angular cheilosis. Ocular examination revealed bilateral severe meibomianitis, multiple superficial punctate keratitides in right eye and corneal epithelial defect in the left eye. Other systemic features were prominent high forehead and large ears. Her father had similar symptoms. Her symptoms improved after adequate treatment of meibomian gland dysfunction. She is asymptomatic at present.

Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a complex eyelid malformation characterized by the classical tetrad of blepharophimosis, telecanthus, ptosis, and epicanthus inversus. It has been reported to be associated with other ocular anomalies such as euryblepharon, strabismus, nystagmus, amblyopia, microphthalmos, lacrimal drainage apparatus abnormality, extra ocular muscle abnormalities, microcornea, trabecular dysgenesis, optic nerve hypoplasias, and colobomas of the optic disk. We describe a case of BPES with Axenfeld-Rieger syndrome, a neurocristopathy characterized by maldevelopment of the anterior segment with predisposition to development of glaucoma. Interestingly, both syndromes are caused by mutations in the same class of genes, namely the winged-helix/forked transcription factors (FOX) involved in a variety of developmental processes.

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.

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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We report a case of delayed onset capsular block syndrome in a patient 6 years after undergoing cataract surgery. Ocular examination revealed marked diminution of vision accompanied with a collection of milky fluid between the intraocular lens and posterior capsule. To treat and to understand the pathology of the condition, aspiration of fluid using 25-gauge vitrector through pars plana was done, and contents sent for microbiological analysis which did not reveal any growth. Postoperative period was uneventful with the absence of intraocular inflammation and excellent visual recovery.