Late-onset capsular bag distension syndrome following cataract surgery

A 74-year-old man presented to the ophthalmology outpatient clinic with reduced visual acuity and increasing haziness of vision in his left eye over several months. Seven years previously he had undergone uneventful cataract surgery with phacoemulsification and insertion of a posterior chamber lens (+14.5 dioptres Alcon MA60BM, 6.0 mm optic) in the same eye. There had been no postoperative complications and his preoperative best-corrected visual acuity of 6/24 had improved to 6/9 four weeks following surgery. The postoperative spherical equivalent refraction was –0.125 dioptres. At the current presentation, his best-corrected visual acuity was 6/9 in the right eye and 6/18 in the left eye. Slit lamp biomicroscopic examination revealed a posterior chamber intraocular lens with a distended posterior capsule and an opaque fluid sequestered between the intraocular lens optic and posterior capsule (retrolenticular pseudohypopyon) (Figure 1). Intraocular pressure was within the normal range and there was no evidence of anterior or posterior segment inflammation. Posterior capsulotomy with Nd:YAG laser was undertaken, and immediately after the posterior capsule was breached, the milky white fluid was observed to pour through the capsulotomy into the vitreous cavity. Upon completion of the capsulotomy the sequestered fluid had disappeared from the capsular bag, the posterior capsule distension had resolved with the lens capsule anatomically positioned immediately behind the intraocular lens optic (Figure 2). Immediate postlaser visual acuity was 6/12, and at follow-up six weeks later, this had improved further to 6/9 with no intraocular inflammation.