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Case Series

Late Postoperative Capsular Block Syndrome Causing Reduced Vision Years After Uncomplicated Cataract Surgery

Sandhaus, Sarah OD1,2*; Flettner, Juliane Grace OD, FAAO3; Mick, Andrew B. OD, FAAO1,2,4

doi: 10.1097/OPX.0000000000001425
REPORTS
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SIGNIFICANCE Late postoperative capsular block syndrome is a treatable complication presenting months to years after cataract surgery using continuous curvilinear anterior capsulorhexis and a posterior chamber intraocular lens implantation. Patients may present to optometric practices because of symptom onset significantly after the immediate post-operative period.

PURPOSE The purpose of this study was to describe the defining clinical features, proposed pathophysiology, and treatment of late postoperative capsular block syndrome. Case 1 was a 68-year-old man who presented with a sudden onset of blurry vision in the right eye 2 years after uncomplicated cataract surgery. Clinical examination revealed turbid fluid distending the posterior lens capsule, a 2-D myopic shift, and an absence of intraocular inflammation. Laser posterior capsulotomy successfully released the trapped fluid and reversed the myopic shift without complication. Case 2 was a 67-year-old man who presented with a gradual onset of hazy vision in the right eye 7 years after uncomplicated cataract surgery. Cloudy fluid was observed to be filling the space between the intraocular lens and the posterior lens capsule, and the refractive error was stable. The fluid was liberated and visual function was restored with uncomplicated laser posterior capsulotomy.

CONCLUSIONS Patients with late postoperative capsular block syndrome may present with blurry vision months to years after cataract surgery performed with continuous curvilinear capsulorhexis and posterior capsule intraocular lens implantation. The defining clinical sign is entrapment of turbid fluid between the intraocular lens and the posterior capsule that may result in reduced vision or refractive error shift. Late postoperative capsular block syndrome is distinguishable from other late complications of cataract surgery, including delayed endophthalmitis or phacoantigenic uveitis, by lack of concurrent robust ocular inflammation.

1San Francisco Veterans Affairs Medical Center, San Francisco, California

2School of Optometry, University of California, Berkeley, Berkeley, California

3Santa Rosa Veterans Affairs Community Outreach Clinic, San Francisco Veterans Affairs Healthcare System, San Francisco, California

4University of California, San Francisco, San Francisco, California

*ssandhaus@berkeley.edu

Submitted: March 9, 2019

Accepted: June 17, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: SS, JF, ABM; Writing - Original Draft: SS; Writing - Review & Editing: SS, JF, ABM.

The authors would like to thank Nicholas Chan, OD, for the contribution of the photograph in Fig. 2, as well as Lauren Hennein, MD, and Dr. Joey Hsia, MD, who performed the laser capsulotomy.

© 2019 American Academy of Optometry