Saturday, September 7, 2013

A Curious Case of Late Onset Vision Loss after Cataract Surgery

A 70-year old man presented with gradual diminution of vision in left eye since 2 years and was referred for YAG laser for Posterior capsular opacification in left eye from elsewhere. He had previously undergone cataract surgery in both eye 10 years back with good visual recovery. On examination, vision in right eye was 6/12 and in the left eye, 3/60.
Slit lamp examination of left eye showed a dense white opacity behind the IOL along with suspected distension of the capsular bag (Figure 1).


AS-OCT confirmed the clinical findings in the left eye showing a hyperintense signal between the posterior capsule and the IOL (Figure 2).

Diagnosis of Left eye Capsular Distension Syndrome was made.
The patient subsequently underwent surgical decompression of the capsular bag along with enlargement of the capsulorhexis to prevent future recurrence of the condition (Video).


Postoperatively, BCVA improved to 6/18 (+1DS -2DC X90) in left eye. The visual axis was clear, with disappearance of the opacity and the eye was quiet (Figure 3).

Postoperative ASOCT also showed absence of hyper intense shadows between the capsule and the IOL (Figure 4).

Take Home Message

  • Not all cases of visual axis opacification following cataract surgery are due to posterior capsular opacification.
  • In cases where the capsulorhexis is much smaller than the IOL optic, conditions like anterior capsular phimosis and capsular distension syndrome can cause late onset loss of vision.


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