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 .
 capsular block syndrome ( cbs ) has been known to occur as a rare complication of cataract surgery with continuous curvilinear capsulorhexis 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 . in this report 
 , we describe a unique case of very - delayed - onset cbs with good visual acuity , occurring 8 years after surgery . 
 it was treated successfully with surgical removal of the opaque material . 
Introduction
Case Report
Discussion