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Sang, Ho, Boo, and Ji: Early Capsular Block Syndrome after Phacoemulsification with Posterior Chamber IOL Insertion Combined with Vitrectomy
Original Article

J Korean Ophthalmol Soc 2013;54(5):716-722.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.5.716

Early Capsular Block Syndrome after Phacoemulsification with Posterior Chamber IOL Insertion Combined with Vitrectomy

Jun Lee Sang, MD1, Yun Kim Ho, MD1, Sup Oum Boo, MD, PhD1, 2, Eun Lee Ji, MD, PhD1, 2

1Department of Ophthalmology, Pusan National University School of Medicine1, Busan, Korea

2Medical Research Institute, Pusan National University2, Busan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 31 August 20127 November 2012       Accepted 6 March 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report early capsular block syndrome (CBS) after phacoemulsification with posterior chamber intraocular lens (IOL) insertion combined with vitrectomy.

Methods

Medical records of 622 eyes of 589 patients who had combined phacoemulsification, IOL implantation and vi-trectomy between March 2009 and December 2011 were retrospectively reviewed. Among patients with CBS occurring within 1 month of surgery, the patient’s baseline characteristics, type of IOL and ophthalmic viscoelastic devices were analyzed.

Results

Nine patients (1.45%) developed CBS with typical capsular bag distension. All CBS occurred within 2 weeks after the surgery. Hydrophilic, large optics and no angulation between optic and haptic were related with the occurrence of CBS. Nd:YAG laser capsulotomy (5 eyes), and surgical capsulectomy (2 eyes) resolved CBS successfully. In 2 eyes with gas tamponade, CBS resolved without intervention with the absorption of gas.

Conclusions

CBS may develop after phacoemulsification with PC IOL insertion combined with vitrectomy and/or vitreous tamponade. Hydrophilic material, large optics and no angulation were risk factors of capsular block by enhancing adhesion between the capsulorrhexis and the optic.

Keywords: Capsular bag distension syndrome, Capsular block syndrome, Combined surgery, Myopic shift

References

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Figure 1.
(A) Slit lamp biomicroscopy shows decreased anterior chamber depth, distended capsular bag (arrows). and IOP increas-ing, corneal edema. (B) After silicone oil removal with surgical posterior capsulectomy, corneal edema resolved and anterior cham-ber depth is normal.
jkos-54-716f1.tif
Figure 2.
(A) Slit lamp biomicroscopy shows accumulation of fluid between the IOL optic and the posterior capsule (arrows). (B) The fluid resolved 5 days later as intravitreal gas decreased.
jkos-54-716f2.tif
Table 1.
Demographics and clinical data of the study patients
Parameter Value
Number of eyes (n) 622
Mean Age (year) ± SD 59.8 ± 22.2
Sex (M/F) 271/351
Mean AL (mm) ± SD 24.5 ± 6.9
Type of IOL No. (%) Optic diameter Angulation Pieces
ZA9003 (AMO) 42 (6.8) 6.0 + 3
1-piece SN60 (Alcon) 114 (18.3) 6.0 - 1
3-piece MA30 (Alcon) 58 (9.3) 5.5 + 3
C-flex 570C or 970C (Rayner) 87 (14.0) 5.75 - 1
Superflex 620H or 920H (Rayner) 213 (34.2) 6.25 - 1
PC-60AD (HOYA) 108 (17.4) 6.0 + 3
Viscoelastics (n) No. (%) Type
Amvisc 219 (35.2) Viscocohesive
Hyal 2000 32 (5.1) Viscocohesive
Discovisc 281 (45.2) Viscodispersive
Healon 5 22 (3.5) Viscocohesive
Healon GV 55 (8.8) Viscocohesive
Viscoat 13 (2.1) Viscodispersive
Diagnosis No. (%)
Macular hole 163 (26%)
Proliferative diabetic retinopathy 144 (23%)
Epiretinal membrane 125 (20%)
Rhegmatogenous retinal detachment 118 (19%)
Retinal venous occlusion 39 (6%)
Others 33 (6%)

SD = standard deviation; AL = axial length; IOL = intraocular lens.

Table 2.
Data of 9 cases
No. Diagnosis Tamponade Cataract (LOCS III) Viscoelastics Intraocular lens
1 PDR with VH None NO2 NC1 C1 P0 Discovisc Superfle× (620H)
2 RRD Silicone Oil (1300 cs) NO1 NC1 C1 P0 Hyal2000 Superfle × (620H)
3 PDR with VH None NO2 NC2 C1 P0 Discovisc Superfle × (620H)
4 RRD C3 F8 NO2 NC2 C1 P0 Discovisc Superfle × (920H)
5 PDR with VH, ERM None NO2 NC2 C3 P3 Discovisc Superfle × (620H)
6 MHRD C3 F8 NO2 NC2 C1 P0 Amvisc Superfle × (620H)
7 Iatrogenic retinal tear Room Air NO3 NC3 C3 P3 Discovisc Superfle × (620H)
8 PDR with VH, TRD SF6 N02 NC2 C0 P0 Amvisc Superfle × (620H)
9 MH, High myopia C3 F8 NO3 NC3 C3 P1 Discovisc Superfle × (920H)

PDR with VH = proliferative diabetic retinopathy with vitreous hemorrhage; RRD = rhegmatogenous retinal detachment; ERM = epiretinal membrane; MHRD = macular hole retinal detachment; TRD = tractional retinal detachment; MH = macular hole.

Table 3.
Clinical findings in capsular block syndrome (CBS) at presentation and resolusion
No Onset (day) V.A (BCVA) At onset A/C depth (CT) V.A (BCVA) After resolution A/C depth (CT) Treatment Refractive shift (D)
Ref (D) IOP (mm Hg) Ref (D) IOP (mm Hg)
1 14 0.32 -2.0 13 3 0.2 0.5 11 3 Surgical capsulectomy +2.5
2 1 NA NA 36 2 NA NA 12 4 Surgical capsulectomy NA
3 1 0.16 -3.0 24 2 0.2 0.2 15 4 Ant. Capsulotomy +3.25
4 1 0.32 -6.0 30 2 0.5 -4.5 12 4 Ant. Capsulotomy +1.5
5 7 NA NA 9 4 NA NA 9 4 Post. Capsulotomy NA
6 1 0.25 -0.5 48 4 0.25 -0.5 14 4 Post. Capsulotomy 0
7 1 0.63 -0.5 16 4 0.63 -0.5 14 4 Post. Capsulotomy 0
8 7 0.125 -2.5 12 3 0.125 -0.75 10 4 Observation +1.75
9 14 NA NA 14 4 0.1 -2.5 16 4 Observation NA

NA = not applicable; CT = corneal thickness.

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