J Korean Ophthalmol Soc.  2018 Jun;59(6):589-593. 10.3341/jkos.2018.59.6.589.

A Case of Late-onset Capsular Block Syndrome, Resulting in the Misdiagnosis of Intraocular Lens Opacity

• Ahn MW
• Kim SH
• Lee JS

• KMID: 2413824
• DOI: http://doi.org/10.3341/jkos.2018.59.6.589

Abstract

PURPOSE
We report a case of late-onset capsular block syndrome, which resulted in a misdiagnosis of intraocular lens (IOL) opacity.
CASE SUMMARY
A 59-year-old man visited our clinic with reduced visual acuity in the right eye from 1 year prior. He had undergone uncomplicated bilateral cataract surgery by phacoemulsification with IOL implants at another hospital 10 years before. There was no specific history with the exception of hypertension. After being diagnosed in the ophthalmology clinic with IOL degeneration and opacity in the right eye, he was referred to our hospital for IOL replacement. Upon examination, his right uncorrected visual acuity was 0.06 and intraocular pressure was 22 mmHg. The refractive error could not be checked due to IOL opacity. Slit-lamp microscopy revealed a cloudy, milky IOL. Anterior-segment optical coherence tomography of the right eye showed retention of a highly reflective material in the lens capsule behind the IOL. Posterior capsule enlargement of the right eye was confirmed on ultrasound biomicroscopy. After neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy was performed, the homogeneous space disappeared and the eye recovered normal visual acuity.
CONCLUSIONS
Capsular block syndrome is a rare complication that can occur shortly (1 day to 2 days) after cataract surgery. Late-onset capsular block syndrome, which occurs 10 years after surgery differs from typical clinical manifestations. Thus, capsular block syndrome is an important consideration upon the presentation of opacification due to IOL degeneration.

Keyword

Capsular block syndrome; Intraocular lens opacification; Misdiagnosis; Neodymium-doped yttrium aluminium garnet (Nd:YAG) laser

MeSH Terms

Cataract
Diagnostic Errors*
Humans
Hypertension
Intraocular Pressure
Lenses, Intraocular*
Microscopy
Microscopy, Acoustic
Middle Aged
Ophthalmology
Phacoemulsification
Refractive Errors
Tomography, Optical Coherence
Visual Acuity
Yttrium
Yttrium

Figure

• 

  Figure 1 Slit lamp photography of the right eye. (A) The anterior capsular incision was fibrous and adhered to the optic part of intraocular lens (IOL), cloudy milky material was observed in the intraocular lens space behind the IOL. And the posterior capsule was swollen. (B) After the neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy, milky white material was not observed behind the intraocular lens space and the uncorrected visual acuity was 1.0.

• 

  Figure 2 Anterior optical coherence tomography and ultrasound biomicroscopy. (A) Anterior segment optical coherence tomography of the right eye showed retention of highly reflective material in the lense capsule behind the intraocular lens. Arrow showed Retention of highly reflective material in the capular bag. (B) Posterior capsule enlargement of right eye was confirmed on ultrasound biomicroscopy. Arrow showed capsular bag distension. IR = infrared; ART = automatic real-time tracking; OCT = optical coherence tomography; HR = high resolution.

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