Assessing Multi-Modal Imaging for Late Capsular Bag Distension Syndrome: A Study of Two Clinical Cases

We report two cases of late capsular bag distension syndrome (LCBDS), which is a rare but significant complication following cataract surgery and often presents with blurred vision years after intraocular lens (IOL) implantation. Case 1: An 80-year-old male presented with a one-year history of progressive blurred vision in the right eye. His history included uneventful phacoemulsification and multifocal IOL implantation eight years earlier. Examination revealed dense, turbid fluid behind the IOL. Scheimpflug imaging and anterior segment optical coherence tomography (AS-OCT) detected hyperintense signals between the IOL and posterior capsule. Nd: YAG laser posterior capsulotomy was performed, resulting in complete resolution of the fluid and recovery of 20/20 vision. Case 2: A 60-year-old hypertensive female reported progressive blurred vision in the right eye for nine months. Ten years earlier, she had undergone uncomplicated cataract surgery. AS-OCT and Scheimpflug imaging demonstrated fluid accumulation posterior to the IOL. Nd: YAG capsulotomy led to complete symptom resolution and restoration of 20/20 vision at the one-week follow-up. This report is among the few in the literature to demonstrate how multimodal imaging, particularly AS-OCT and Scheimpflug imaging, can distinctly differentiate late capsular bag distension syndrome from posterior capsule opacification, enabling accurate diagnosis and appropriate management.

Keywords: Capsular distension, multimodal imaging, Nd: YAG laser