capsular block syndrome ( cbs ) has been known to occur as a rare complication of cataract surgery with continuous curvilinear capsulorhexis ( ccc ) and a posterior - chamber lens implant . typically , it presents with reduced vision in the early postoperative period and is characterised by a forward displacement of the posterior - chamber intra - ocular lens and an accumulation of intra - capsular opaque material . management of cbs is usually by nd : yag laser capsulotomy . we describe here a unique case of very - delayed - onset cbs with good visual acuity , occurring 8 years after surgery . a 75-year - old lady was referred to the eye department with a 6-month history of misty and fuzzy vision in her right eye . eight years earlier , she had undergone uncomplicated bilateral cataract surgery by phacoemulsification with lens implants . upon examination , her logmar scale best - corrected visual acuity ( bcva ) was 20/20 in both eyes . refractive error was 1.50 ds for the right eye and + 0.25 ds for the left eye , which suggested a myopic shift in the right eye . the left eye was normal , but there was a hazy appearance in the right eye in the retro - lenticular space between the posterior surface of the lens optic and the posterior capsule . the space was homogenously whitish and slightly opalescent , characteristic of a milky , turbid fluid ( fig . 1 ) . there were no signs of inflammatory activity . on clinical examination , the lens implant did not appear to have shifted forward and the fundus examination was normal . intra - operatively , a 30-gauge needle mounted on a 1-ml syringe was passed through the sclera and pars plana , 3.5 mm behind the limbus in the infero - temporal quadrant . the needle tip was gently passed through the posterior capsule and 0.2 ml of the turbid fluid was aspirated and then sent for microbiological culture and analysis . intra - vitreal vancomycin ( 1 mg/0.1 ml ) was administered at the end of the procedure . she was reviewed after 5 days and there were no signs of inflammation or endophthalmitis . in addition , her myopic shift had disappeared and she now had a + 0.25 ds for both eyes , both still with a bcva of 20/20 . two months afterwards , at follow - up , she was asymptomatic and reported complete resolution of her misty vision . examination showed a bcva of 20/20 , with a clear papillary axis and an intact posterior capsule and lens implant . it is mainly known to occur with ccc and phacoemulsification , but has also been reported with can - opener - type capsulorhexis , extracapsular cataract extraction   and intra - ocular lens implantation in the sulcus [ 4 , 5 ] . our case did not have reduced visual acuity and only had symptoms of haziness and mistiness , which is quite unusual and , to the best of our knowledge , has not been reported in the literature before . miyake et al .   divided the condition into 3 different types , depending upon the time of onset : intra - operative , early post - operative and late post - operative . they postulated that , in the late post - operative period , the cortical cells undergo metaplastic changes and proliferate in the bag , which leads to posterior capsular opacification and also causes occlusion of the capsular opening by sealing off the gap between the anterior capsule and the lens implant . these metaplastic cells also cause the release of a turbid fluid , which gets retained in the retro - lenticular space . upon electrolysis , this fluid has been found to be made of alpha - crystallin and collagen released from the necrotic and/or apoptotic autolysed cells [ 7 , 8 ] . eifrig   described 3 cases with capsulorhexis - related lacteocrumenasia ( lacteo = milky and crumen = small bag or coin purse ) . the aspirated fluid was examined with electrophoresis and showed a large amount of alpha - crystallin and a small amount of albumin . the study concluded that it was unlikely to be a result of an antigen - antibody reaction in the capsular bag as there was no gamma globulin detected . there have been a few reports of late - onset cbs being linked to propionibacterium acnes [ 9 , 10 ] . carlson and koch   reported a case of p. acnes - associated endophthalmitis after nd : yag laser capsulotomy . these reports led us to err on the side of caution , and we therefore opted to perform the aspiration of the fluid via the pars plana , rather than using the conventional approach of nd : yag laser capsulotomy . our case had the unique feature of a very late presentation 8 years after an uncomplicated phacoemulsification and ccc . in addition , in comparison to most of the reported literature where the visual acuity was dramatically reduced , our patient had a bcva of 20/20 and only had symptoms of misty vision with a reduction in her contrast sensitivity , which improved after the aspiration of the fluid . in summary , late - onset cbs can present after a long time and may cause significant symptoms . the usual treatment for the condition is nd : yag laser capsulotomy , but an infective aetiology could be present and this may cause a dissemination of intra - ocular infection . we have described a pars plana removal technique with simultaneous administration of intra - vitreal antibiotics , which we believe is a safe approach for this condition .