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Eva Monestam; Asymtomatic Capsular Bag Distension 10 years After Cataract Surgery, 7 Case Reports. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6629.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the occurrence of asymptomatic capsular bag distension 10 years after uneventful phacoemulsification with intraocular lens (IOL) implantation.
A subgroup of 126 patients who were part of a longitudinal long-term study on cataract surgery outcome had a routine eye examination and Scheimpflug photography (Pentacam®) of the anterior segment and the intraocular lens, 10 years after surgery. None of the patients had previously had posterior capsulotomy. Examination by slit-lamp found seven patients (6% of the total) with distended capsular bags of different degrees. The distension was confirmed and measured using Scheimpflug photography.
The IOL was in all cases an Acrysof® (MA60BM; Alcon Inc). Best corrected visual acuity (BCVA) was logMAR (0,32 (20/38) - -0,18 (20/17)). All 3 patients with a BCVA less than 20/24 had previously diagnosed age-related maculopathy. The difference between high contrast BCVA and low contrast visual acuity 10% was between normal limits (0,3 - 0,48 logMAR units) for all patients. The distance between the IOL and the posterior capsule was between 300 and 650µm. One patient died 6 months after the examination, and 3 patients had neodymium:YAG capsulotomy between 6 months to 2 years after the examination. More than 4 years after the examination 3 patients still had no need for capsulotomy.
This study suggests there is an asymptomatic time span in cases with late onset capsular bag distension syndrome. It is important to be aware of this syndrome when examining patients who had cataract surgery many years previously and no posterior capsulotomy. If there is a tendency for accumulation of fluid behind the intraocular lens some patients will need posterior capsulotomy within a few years, especially if the distance between the IOL and the posterior capsule is more than 500 µm.
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