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Mind the gap!
  1. Abdul-Jabbar Ghauri,
  2. Pravin Pandey,
  3. Maged Nessim
  1. Department of ophthalmology, Glaucoma & Cataract services, Birmingham and Midland Eye Centre, Birmingham, UK
  1. Correspondence to Maged Nessim, Department of ophthalmology, Birmingham and Midland Eye Centre, Dudley Road, Birmingham B18 7QU, UK; maged.nessim{at}nhs.net

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Capsular distension syndrome is a rare but easily treatable complication of cataract surgery that can lead to a reduced vision. This should be excluded in all patients presenting with a postoperative refractive surprise.

Case report

A 76-year-old woman was referred to our clinic for an intraocular lens (IOL) exchange 18 months after uneventful cataract surgery. She was emmetropic, preoperatively, with an unaided visual acuity (VA) of counting fingers at 1 m, improving to 6/18 with pinhole. The right eye was already pseudophakic with an unaided VA of 6/6 and a refraction of −0.75/−0.25 at 130°. Apart from a left posterior subcapsular cataract, no additional ocular comorbidites were identified preoperatively. She underwent uneventful phacoemulsification with a 21D monofocal-refractive, hydrophilic, acrylic one-piece posterior chamber intraocular lens (PC/IOL). Four weeks postoperatively, her unaided VA was 6/60 improving to 6/9 with pinhole; she was, however, lost to follow-up, and no refraction was available in her medical records. She was rereferred 18 months later by her optician with symptoms of anisometropia. VA in the left eye on this occasion was 6/60 unaided, improving to 6/18 with pinhole. Refraction on this occasion was −3.00/−0.50 at 40°. She was subsequently referred to the anterior segment service for IOL exchange.

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