Capsulorhexis Block Syndrome

Introduction:

Cataract surgery is the surgical intervention done to remove the intraocular lens (IOP) of the eye and replace it with artificial lens implants. The lens is clear in healthy eyes, while cataracts cause the lens to become cloudy, affecting one’s vision. Cataract surgery can lead to certain complications in a few months or years. One such rare complication is capsulorhexis block syndrome, where the turbid fluid gets trapped with the replacement of the intraocular lens implant.

What Is Cataract Surgery Used For?

Cataract surgery is used to treat cataracts, which are clouding of the natural lens in the eye. This clouding can cause vision impairment and, if left untreated, may lead to blindness. Cataract surgery incorporates the elimination of the cloudy lens and replacing it with an appropriate artificial intraocular lens (IOL). The primary purposes of cataract surgery are:

• Restoring vision.

• Enhancing the vision clarity.

• Correction of refractive errors.

• Improving the quality of life.

• Reduction of glare and sensitivity.

What Is Capsulorhexis Block Syndrome?

Capsulorhexis block syndrome is relatively a rare complication of cataract surgical procedure with intraocular lens replacement. Here, the turbid fluid accumulates within the intraocular lens and posterior (back part) of the capsular, resulting in the depletion of visual acuity. This condition can occur within a few weeks, months, or years following cataract surgery. The prevalence of Capsulorhexis syndrome is rare, occurring in less than one percent of individuals undergoing phacoemulsification procedures in conjugation with a posterior chamber intraocular lens (PCIOL).

The other names for Capsulorhexis block syndrome include the following.

• Capsular block syndrome.

• Capsular bag distension syndrome.

• Capsular bag hyperdistension.

What Is the Cause of Capsulorhexis Block Syndrome?

This syndrome is typically a complication after cataract surgery where the capsular bag (a small portion of the anterior capsule with the entire posterior capsule) accumulates within the intraocular lens and posterior capsule. Here, the capsule is the basement membrane surrounding the ocular lens.

The trapped fluid of the eye could lead to the distension of the posterior capsule and the frontward displacement of the intraocular lens. Certain studies suggest that individuals with eyes of axial length greater than 25 millimeters possess a greater risk for capsulorhexis block syndrome. Moreover, people receiving four haptic posterior chamber intraocular lenses (PCIOL) are found to be at higher risk.

What Are the Types of Capsulorhexis Block Syndrome?

The clinical studies show four distinctive types of capsulorhexis block syndrome:

• Type 1: Here, the liquid and capsule are transparent. This type is barely visualized through slit lamp biomicroscopy. But, it gives a clear view of optical coherence tomography (OCT).

• Type 2: In this type, fluid consistency in the capsular bag is homogeneous and milky.

• Type 3: The accumulation of transparent or semitransparent liquid is seen in this type.

• Type 4: Here, there is opaque content in the posterior capsule.

What Are the Signs and Symptoms of Capsulorhexis Block Syndrome?

The signs and symptoms of capsulorhexis block syndrome include the following:

Symptoms:

Individuals with capsulorhexis block syndrome experience any of the following symptoms.

• A decline in visual acuity.

• Foggier or cloudier vision.

• Eye pain.

• Eye irritation.

• Redness.

• Blurred vision.

Signs:

On examination, healthcare providers might come across the following findings in people with capsulorhexis syndrome.

• Increased space within the optic and posterior capsules.

• Frontward displacement of the iris and lens diaphragm.

• Increased intraocular pressure (IOP).

• Decreased anterior chamber depth.

• Synechiae formation (abnormal adhesion between the iris and lens or cornea).

What Are the Complications of Capsulorhexis Block Syndrome?

If capsulorhexis block syndrome is left unaddressed and untreated, it can potentially result in the following complications:

• Glaucoma (a group of eye health conditions resulting in blindness and vision loss due to transient damage to the optic nerve).

• Posterior synechiae formation. Here, the iris adheres to the lens, bypassing the flow of aqueous humor (eye fluid) from the back to the front region of the eye.

• Posterior capsule opacification results when a cloudy layer of scar tissue is formed behind the implanted lens.

How Is Capsulorhexis Block Syndrome Diagnosed?

The ophthalmologists undergo a comprehensive eye examination for individuals who present with symptoms like decreased visual acuity and blurry vision. The intraocular pressure is then evaluated. The diagnosis of capsulorhexis block syndrome can be made with the following techniques.

• Slit Lamp Examination: A slit lamp is used in conspicuous cases. The turbid and opaque fluid is well visualized within the intraocular lens and posterior capsule.

• Optical Coherence Tomography: Anterior segment optical coherence tomography (OCT) is also used to evaluate the condition. This can be used before and after the Yttrium Aluminium Garvey (YAG) capsulotomy. Using this technique, the chamber depth and the motility of the lens-iris diaphragm can be measured.

• Ultrasound Biomicroscopy: This technique is chiefly used to image the anterior segment, or front portion, of the eye. This helps in the case of intense distension of the capsular bag.

• Scheimpflug Camera: This imaging technique visualizes the anterior segment of the eye, providing appropriate data.

How Is Capsulorhexis Block Syndrome Managed?

The doctors consider effective treatment options after the diagnosis. Capsulorhexis block syndrome is usually treated with Nd YAG laser capsulotomy. This is a non-invasive approach generally indicated for the management of opacities in the posterior capsule causing visual acuity decline. This helps release the trapped fluid with the return of the intraocular lens and iris-lens diaphragm to their actual positions. As a result, the myopic shift is resolved with improved visual acuity.

The other possible treatment options for capsulorhexis block syndrome include:

• Observation.

• Anti-inflammatory medicated eye drops.

• Surgical aspiration of the cortical fluid and mass.

• Pars plana vitrectomy (a surgical procedure used to remove scar tissue or vitreous humor by inserting specialized tools into the area of the sclera called the pars plana).

Prognosis:

The prognosis for capsulorhexis block syndrome is excellent and favorable only with certain YAG laser applications done to eliminate turbid fluid. Moreover, the individuals are known to regain baseline visual acuity.

Conclusion:

Capsulorhexis block syndrome can occur in people who have undergone cataract surgery. This can prolapse the lens implant, affecting visual acuity. It is essential to note that each experience has distinct manifestations, and the treatment approach might vary based on the circumstances. However, aspiration for fluid and appropriate management serve as crucial factors in attaining the best outcome and prognosis for the condition.