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 Table of Contents  
Year : 2019  |  Volume : 57  |  Issue : 4  |  Page : 332-333

Scheimpflug imaging in the late postoperative capsular bag distension syndrome

Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission19-Oct-2019
Date of Decision24-Oct-2019
Date of Acceptance28-Oct-2019
Date of Web Publication26-Dec-2019

Correspondence Address:
Dr. Krati Gupta
Sri Sankaradeva Nethralaya, 96, Beltola, Guwahati - 781 028, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjosr.tjosr_91_19

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How to cite this article:
Gupta K, Bhattacharjee H, Deshmukh S. Scheimpflug imaging in the late postoperative capsular bag distension syndrome. TNOA J Ophthalmic Sci Res 2019;57:332-3

How to cite this URL:
Gupta K, Bhattacharjee H, Deshmukh S. Scheimpflug imaging in the late postoperative capsular bag distension syndrome. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2021 Sep 26];57:332-3. Available from: https://www.tnoajosr.com/text.asp?2019/57/4/332/273993

  Manuscript Top

Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery within the bag intraocular lens (IOL) implantation. CBDS is characterized by the build-up of the turbid fluid between the IOL and the posterior capsule. It is also known as capsular block syndrome, capsulorhexis block syndrome, or capsular bag hyperdistention. It later leads to decline in the visual acuity of the patient.[1]

  Epidemiology Top

Literature review shows the incidence of CBDS to be 0.73% in patients who undergo phacoemulsification with in-the-bag IOL implantation. It has also been reported that CBDS can present from weeks to even years after the cataract surgery.[2]

  Pathophysiology Top

Depending on the time of onset, CBDS can be classified into three types, namely, intraoperative, early postoperative, and late postoperative. Intraoperative CBDS develops at the time of surgery and is believed to occur as a result of high irrigation pressure during the hydrodissection to separate the cataractous lens from the capsular bag. Pressure built up may lead to posterior capsular rupture. Early postoperative CBDS is believed to occur due to retained viscoelastic material behind the IOL. Late CBDS cause is unknown but is assumed to be caused due to occlusion of the capsulotomy by the optic of the IOL which prevents the free flow of fluid through this aperture.[3]

  Diagnosis Top

The patient presents with the complaint of diminution of vision. There may also be increased intraocular pressure due to anterior displacement of the lens-iris diaphragm. Slit-lamp examination (SLE) shows the presence of fluid between the lens and the posterior lens capsule. The fluid may be clear or turbid. Anterior segment optical coherence tomography and ultrasound biomicroscopy can help in the confirmation of the diagnosis and also help in the diagnosis of cases with minimal fluid, which may be missed on SLE. Scheimpflug imaging may be clinically useful to document morphologic changes in the anterior segment in CBDS.[4],[5]

  Case Report Top

A 56-year-old-male patient underwent phacoemulsification with posterior chamber IOL implantation in the left eye (OS). The patient complained of diminution of vision in the OS at 2-year follow-up. The best-corrected visual acuity (BCVA) was 20/40 OS and 20/20 in the right eye. SLE and Scheimpflug imaging showed the presence of turbid fluid between IOL and posterior capsule, suggestive of CBDS. The patient was successfully managed with neodymium-doped yttrium aluminum garnet capsulotomy and the BCVA improved to 20/20 [Figure 1]a, [Figure 1]b, [Figure 1]c].
Figure 1: (a) Slit-lamp photograph showing distended capsular bag. (b) Scheimpflug imaging showing increased posterior chamber intraocular lenses-posterior capsule distance. (c) Diagrammatic representation showing the pathogenesis of capsular bag distension syndrome

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  Conclusion Top

This article highlights the use of Scheimpflug imaging in the diagnosis of the CBDS.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


We would like to thank Sri Kanchi Sankara Health and Educational Foundation and the patient for granting permission to publish this information.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bhattacharjee H, Bhattacharjee K, Bhattacharjee P, Das D, Gogoi K, Arati D. Liquefied after cataract and its surgical treatment. Indian J Ophthalmol 2014;62:580-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
Kim HK, Shin JP. Capsular block syndrome after cataract surgery: Clinical analysis and classification. J Cataract Refract Surg 2008;34:357-63.  Back to cited text no. 2
Miyake K, Ota I, Miyake S, Horiguchi M. Liquefied aftercataract: A complication of continuous curvilinear capsulorhexis and intraocular lens implantation in the lens capsule. Am J Ophthalmol 1998;125:429-35.  Back to cited text no. 3
Jain R, Grewal D, Gupta R, Grewal SP. Scheimpflug imaging in late capsular bag distention syndrome after phacoemulsification. Am J Ophthalmol 2006;142:1083-5.  Back to cited text no. 4
Zhu XJ, Zhang KK, Yang J, Ye HF, Lu Y. Scheimpflug imaging of ultra-late postoperative capsular block syndrome. Eye (Lond) 2014;28:900-4.  Back to cited text no. 5


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