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Editor,—The advantages of continuous curvilinear capsulorrhexis (CCC) for phacoemulsification cataract surgery are well known.1 We report a case of capsular bag distension syndrome, a complication of capsulorrhexis.
An 80-year-old female patient underwent uncomplicated phacoemulsification via a temporal corneal incision. A 23.0 dioptre foldable posterior chamber intraocular lens (Allergan SI30 NB, 6.00 mm biconvex silicone optic, 13.00 mm polypropylene modified C haptics with 10° posterior angulation) was inserted into the capsular bag following the injection of ProVisc (sodium hyaluronate 1%).
Slit-lamp examination on the first postoperative day showed the IOL to be displaced anteriorly within the capsular bag with the posterior capsule lying well behind the optic. As the patient was pain free and the cornea was clear, the intraocular pressure was not measured. The anterior chamber showed minimal activity.
At review 2 weeks later, the visual acuity was 6/9 with a refraction of −3.00 DS/−0.50 DC at 120°, biometry having predicted a postoperative spherical equivalent refraction of −0.35 DS. The intraocular pressure was 10 mm Hg.
Five weeks postoperatively, the visual acuity was 6/9 with a −1.50 DS trial lens, and at 11 weeks, the same visual acuity was attained with a −0.75 DS lens. The IOL was observed to have progressively settled more posteriorly at each examination.
Slit-lamp examination after dilating the pupil showed a vertically oval anterior capsulorrhexis opening measuring 3.5 mm by 4.5 mm in size, slightly eccentric supertemporally (Fig 1).
Retained viscoelastic, transudation through the lens capsule, and exudation from lens epithelial cells are possible sources of the fluid causing capsular bag distension. The fact that the syndrome was recognised on the first postoperative day in this case almost certainly implicates entrapment of viscoelastic solution behind the IOL. The small capsulorrhexis opening relative to the 6 mm optic, we feel, contributed to the entrapment.
The syndrome has been reported following implantation of both PMMA IOLs and silicone IOLs, with either angulated or non-angulated haptics.3 YAG laser peripheral anterior capsulotomy has been successfully performed in cases of slowly resolving myopia23 and in one case of apparent closure of the peripheral anterior chamber angle with elevated intraocular pressure.3
As the myopic shift lessened gradually with a satisfactory refractive outcome in our case, conservative management was felt to be appropriate.
We suggest care in making the capsulorrhexis opening adequate and in ensuring that the viscoelastic is removed from behind the implant at the end of surgery.