Imaging late capsular bag distension syndrome: an anterior segment optical coherence tomography study

Yar Li Tan,^1,2 Lakshmanasamudram S Mohanram,¹ Seng Ei Ti,^1,2 Tin Aung,^1–3 Shamira Perera<sup>1,2

1</sup>Singapore National Eye Centre, ²Singapore Eye Research Institute, ³National University of Singapore, Yong Loo Lin School of Medicine, Buona Vista, Singapore

Background: Anterior segment optical coherence tomography (ASOCT) was used to categorize and provide insights into the etiology of capsular bag distension syndrome (CBDS).
Methods: A prospective review was undertaken of 10 cases who presented with signs of late CBDS 5–11 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation.
Results: All 10 patients presented with a milky collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. ASOCT was used to confirm the diagnosis in all cases, and a hyperintense signal was seen in the space between the posterior chamber intraocular lens and the posteriorly bowed posterior capsule. The continuous curvilinear capsulorhexis was measured to be between 3.18 mm and 4.70 mm. Three cases had uncorrected visual acuity better than 6/12. Uncomplicated Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in eight patients, with no resulting change in the intraocular lens position (measured by ASOCT) or subjective refraction.
Conclusion: Our study showed that ASOCT is a useful modality to differentiate this condition clearly from posterior chamber intraocular lens opacification and to investigate its causation. Nd:YAG posterior capsulotomy proved to be a safe and successful treatment for late CBDS with no change in biometric or refractive parameters.

Keywords: anterior segment optical coherence tomography, capsular bag distension syndrome, YAG capsulotomy