Posters

Late onset posterior capsulardistension syndrome (PCDS) following phacoemulsification: a case series

Poster Details

First Author: S.Basak INDIA

Co Author(s):                  

Abstract Details

Purpose:

Early postoperative posterior capsular distension syndrome (PCDS) with in-the bag IOL implantation is known in the literature. The purpose of this study is to report a series of late onset posterior capsular distension syndrome with significant visual loss in patients with in-the-bag PC IOL implantation following phacoemulsification.

Setting:

Disha Eye Hospitals & Research Centre, Kolkata, West Bengal; 700120, India.

Methods:

Retrospective review of charts of 34 patients who presented with late significant visual loss following phacoemusification in our hospital during last 10 years. In all cases PC IOL implantation in-the-bag were performed between 2003 and 2009. In all cases, the type, material and design of IOL was noted. Refractive errors, best spectacle corrected visual acuity (BSCVA), intraocular pressure (IOP) and slit lamp photographic documents after full pupillary dilation were recorded. Nd:YAG posterior capsulotomy was required in all eyes. Post-YAG, all eyes received nepafenac eye drop three time daily for 4-6 weeks. Refractive correction, BSCVA, and complications if any were recorded in all cases after 3 weeks and at 3 months following YAG capsulotomy.

Results:

27 eyes had 3-piece (AcrySof MA60BM) and 3 had single-piece hydrophobic acrylic (AcrySof SA60AT) IOL and two with AcrySof Natural IOL (SN60AT). Only two eyes had single-piece (6.5 mm) PMMA IOL implantation. The minimum gap after phacoemulsification to presentation with PCDS was 4 years 1 months and the maximum gap was 8 years with a mean of 5.6 ± 1.7 years. None of the IOLs was of silicone or hydrophilic acrylic material. In all cases, the capsular bags were significantly distended posteriorly with milky fluid within them. There were some amount of anterior shifting of the IOL compared to other eye. All eyes had myopic shift of 0.50 ± 0.15D as indicated by difference in refraction after YAG posterior capsulotomy. 29 patients regained BSCVA of 20/20 and 5 had 20/40 vision after 3 weeks. No complications encountered after capsulotomy within 3 months.

Conclusions:

Late posterior capsule distension syndrome mostly occurs with in-the-bag hydrophobic acrylic IOL implantation with maximum with 3-piece IOL. Nd:YAG posterior capsulotomy is required to treat this unique condition and the patients regain vision immediately after it without any complication. The mechanism of this phenomenon with hydrophobic IOL is not well understood. The question of reduction in bioadhesive property of hydrophobic IOL material with time is to be addressed in future. FINANCIAL INTEREST: NONE