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Background: Capsular bag distension syndrome (CBDS) can be effectively treated using either Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy or surgery. Assessing anterior segment, particularly immediately after Nd:YAG laser capsulotomy, could provide clinically relevant information on ocular dynamics, refractive changes, and complication mechanisms, especially in late postoperative CBDS.Objective: To explore the acute effects of Nd:YAG laser posterior capsulotomy on anterior segment parameters in late postoperative CBDS.Methods and results: In this study, 20 patients underwent Nd:YAG laser posterior capsulotomy after cycloplegia, during which milky-white fluid material migrated into the anterior vitreous. Anterior segment parameters were assessed before and immediately after laser using Scheimpflug-Placido topographer. The main outcome measures were differences in best-corrected visual acuity (BCVA), aqueous depth (AqD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume (CV), and central corneal thickness (CCT) at the baseline versus at immediately after laser. The mean age and duration since surgery for CBDS presentation were 70.25 ± 6.21 and 6.15 ± 1.31 years, respectively. The AqD, ACV, ICA, and spherical equivalent increased significantly compared with baseline (4.18 vs. 4.02 mm, p = 0.001; 177 vs. 173.55 mm³, p = 0.004; 51.15° vs. 50.15°, p = 0.023; −1.00 vs. −2.00 D, p = 0.003, respectively). These changes were also associated with significantly improved BCVA an hour after capsulotomy [0.2 (0.05–0.2)] relative to baseline [0.3 (0.2–0.5)], (p = 0.001). CCT and CV decreased nonsignificantly; horizontal AC diameter and K1 and K2 increased nonsignificantly (p > 0.05).Conclusions: Nd:YAG laser posterior capsulotomy appears to be an effective CBDS treatment for acutely improving vision, potentially due to immediate refractive changes caused by altered anterior segment parameters. [ABSTRACT FROM AUTHOR]

Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery characterized by collection of turbid fluid between the posterior surface of the intraocular lens (IOL) and the posterior capsule. Here, we report a case of CBDS presenting 7 years after uneventful cataract surgery. Patient presented with blurring of vision in the right eye and his best corrected visual acuity (BCVA) was 6/9 N6. Slit lamp examination showed collection of turbid fluid between IOL and posterior capsule, and the opaque fibrosed capsulorhexis margin was adherent to the optic of IOL which was well placed within the bag. Patient underwent neodymium yttrium aluminium garnet (ND-YAG) laser posterior capsulotomy to release the fluid into the vitreous cavity. 6 weeks after the procedure his BCVA improved to 6/6 N6.

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.

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 investigate the prevalence and morphologic and clinical features of posterior capsule-optic inadhesion following cataract surgery. Methods In this prospective cohort study, we examined 518 consecutive patients who had undergone uneventful phacoemulsification and posterior chamber intraocular lens ( IOL) implantation. They were assigned into five groups based on the type of IOL used: MC X11 ASP, Rayner 920H A, ZCB00, SN60 WF and KS-3Ai. Routine ophthalmic examinations were performed. Patients were followed up at 1 day, 1 week, and 1 and 2 months postsurgery. Anterior segment photography, Scheimpflug imaging and KR-1W aberrometry were conducted after the patients' pupils were dilated. Results The overall rate of posterior capsule-optic inadhesion on the first day after surgery was 215/518 (41.5%), and it decreased to 37/518 (7.1%) at 2 months postsurgery. Posterior capsule-optic inadhesion can be morphologically classified into five types with three outcomes, of which gradual absorption of the accumulated fluid predominated for all IOLs. The clinical characteristics of patients with inadhesion varied with IOL type. Notably, visual quality data (Strehl ratios and modulation transfer function) were poorer in patients with posterior capsule-optic inadhesion, especially in those with irregular forms of suspension. Four cases of capsular contraction syndrome were identified among the patients with inadhesion. Conclusions Posterior capsule-optic inadhesion is a prevalent capsule- IOL interaction following cataract surgery. Although the accumulated fluid is absorbed in the majority of patients, its adverse effects on visual outcomes, especially visual quality in the operated eye(s), must not be underestimated in patients with persistent inadhesion. [ABSTRACT FROM AUTHOR]

Background Posterior capsule opacification (PCO) is the most common post-operative complication associated with cataract surgery and is mostly treated with Nd:YAG laser capsulotomy. Here, we demonstrate the use of high-resolution spectral-domain optical coherence tomography (OCT) as a technique for PCO analysis. Additionally, we evaluate the influence of PCO types and the distance between the intraocular lens (IOL) and the posterior capsule (PC), i.e., the IOL/PC distance, on the total-pulse energy required for the Nd:YAG laser posterior capsulotomy. Methods 47 eyes with PCO scheduled for the Nd:YAG procedure were examined and divided into four categories: fibrosis, pearl, mixed type and late-postoperative capsular bag distension syndrome. Using custom-made computer software for OCT image analysis, the IOL/PC distances in two dimensions were measured. The IOL/PC distances were compared with those of a control group of 15 eyes without PCO. The influence of the different PCO types and the IOL/PC distance on the total-pulse energy required for the Nd:YAG procedure was analyzed. Results The total-pulse energy required for a laser capsulotomy differs significantly between PCO types (p =0.005, Kruskal-Wallis test). The highest energy was required for the fibrosis PCO type, followed by mixed, pearl and late-postoperative capsular bag distension syndrome. The IOL/PC distance also significantly influenced the total-pulse energy required for laser capsulotomy (p =0.028, linear regression). Lower total-pulse energy was expected for a larger IOL/PC distance. Conclusions Our study indicates that the PCO types and the IOL/PC distance influence the total-pulse energy required for Nd:YAG capsulotomy. The presented OCT method has the potential to become an additional tool for PCO characterization. Our results are important for a better understanding of the photodisruptive mechanisms in Nd:YAG capsulotomy. [ABSTRACT FROM AUTHOR]

Background: Anterior segment optical coherence tomography (ASOCT) was used to categorize and provide insights into the etiology of capsular bag distension syndrome (CBDS). Methods: A prospective review was undertaken of 10 cases who presented with signs of late CBDS 5-11 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation. Results: All 10 patients presented with a milky collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. ASOCT was used to confirm the diagnosis in all cases, and a hyperintense signal was seen in the space between the posterior chamber intraocular lens and the posteriorly bowed posterior capsule. The continuous curvilinear capsulorhexis was measured to be between 3.18 mm and 4.70 mm. Three cases had uncorrected visual acuity better than 6/12. Uncomplicated Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in eight patients, with no resulting change in the intraocular lens position (measured by ASOCT) or subjective refraction. Conclusion: Our study showed that ASOCT is a useful modality to differentiate this condition clearly from posterior chamber intraocular lens opacification and to investigate its causation. Nd:YAG posterior capsulotomy proved to be a safe and successful treatment for late CBDS with no change in biometric or refractive parameters. [ABSTRACT FROM AUTHOR]

To report four cases of capsular bag distension syndrome (CBDS) after combined cataract and glaucoma surgery.We describe the clinical features and evolution of each case after individual treatment.We report four cases of CBDS after phacoemulsification, combined with trabeculectomy in two cases and with an Ahmed aqueous drainage device implantation in the other two cases. The space between the intraocular lens (IOL) and the posterior capsule was occupied by an optically clear liquid in two cases and by a turbid liquid in the other two cases, with posterior bowing of the capsule into the anterior vitreous. A myopic shift and anterior chamber shallowing occurred in three cases. After posterior Nd:YAG laser capsulotomy, the CBDS resolved in three cases. In case 1, a surgical posterior capsulotomy and anterior vitrectomy were necessary.Capsular bag distension syndrome should be included in the differential diagnosis of a shallow anterior chamber after combined cataract and glaucoma surgery. [ABSTRACT FROM AUTHOR]

La capsulorrexis es el método preferido para la realización de la capsulotomía anterior. El síndrome de distensión del saco capsular es una complicación posoperatoria poco frecuente asociada a esta técnica. En este artículo presentamos un caso clínico de una mujer de 70 años, que presentaba una catarata nuclear dura en ojo izquierdo, a la cual se le realizó cirugía extracapsular técnica de Mini Nuc de Blumenthal, con capsulorrexis anterior e implante de LIO de Polimetil Metacrilato en cápsula posterior. Un mes más tarde la paciente acude con disminución de la visión, con sobrerrefracción miópica postoperatoria y desplazamiento anterior del lente. Se realizó capsulotomía anterior periférica con láser Nd YAG que resolvió la complicación, con recuperación de la profundidad de la cámara anterior y reposicionamiento del lente. La capsulotomía anterior periférica con láser es la mejor opción terapéutica, al ser inocua, de rápida recuperación, excelentes resultados visuales y mínimas complicacionesCapsulorrhexis is the preferred method to perform anterior capsulotomy. Capsular bag distension syndrome is one of the less frequent postoperative complications associated to this technique. This article prresented the clinical case of a 70-years-old woman who presented with hard nuclear cataract in hter left eye and underwent an extracapsular surgery by Mini Nuc technique, with anterior capsulorrhexis and polymethyl-metacrylate IoL implant in posterior capsule. A month after surgery, the patient went to the doctor´s with reduced vision, posoperative myopic overrefraction and anterior displacement of the lens. Then, peripheral anterior capsulotomy with Nd YAG laser was used to overcome this problem; anterior chamber depth and repositioning of the lens were recovered. Peripheral anterior capsulotomy with laser is the best therapeutic choice since it is harmless, and offers rapid recovery, excellent visual results and minimal complications

Purpose: Capsular bag distension syndrome is to be seen as a relatively rare complication after cataract surgery., Materials and Methods: We describe our experience of late-onset capsular bag distension syndrome with one case onset 4 years after cataract surgery. Nowadays diagnostic imaging methods were used. The literature was reviewed to summarize the diagnosis, classification, use of diagnostic aids, and the current treatments for the capsular bag distension syndrome. Visual acuity was assessed using the ETDRS (Early Treatment Diabetic Retinopathy Study) chart., Discussion: A 72-year-old woman presented with decreased visual acuity and blurred vision 4 years after phacoemulsification with continuous curvilinear capsulorhexis (CCC) and in-the-bag IOL implantation. After the slit lamp examination, patient was investigated with Scheimpflug camera (OCULUS Pentacam HR) and anterior segment spectral domain OCT (Optovue, Avanti RTVue XR), which confirmed the diagnosis of capsular block syndrome. Aspiration of the turbid fluid behind the lens and capsular bag lavage resulted in resolution of her symptoms. Aspirated fluid was examined. We have observed no CBS recurrence., Conclusion: CBS is the relatively rare complication of the standard cataract surgery, which can occur during surgery and in a postoperative period. CBS can be solved successfully after regular diagnosis using modern imaging methods.

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.

Objective: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP)., Subjects, Material and Methods: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test)., Results: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO(®) (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim(®) IOL (PhysIOL)., Conclusions: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO(®) could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim(®)) are implanted., (Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)