Late-Onset Capsular Block Syndrome: Unusually Delayed Presentation
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. Her left eye was asymptomatic. 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. ). 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.\nShe agreed to undergo surgical removal of this fluid under local anaesthesia. 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. The microbiological report did not show any signs of indolent bacterial growth. 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. Inferiorly, there was opacity of the posterior capsular area (fig. ).