Anterior capsulotomy for early postoperative capsular block syndrome: sequential imaging approach with AS-OCT

Introduction: Early postoperative capsular block syndrome (CBS) is a rare complication of cataract surgery. We aim to describe its clinical and serial imaging characteristics, through high-definition anterior segment optical coherence tomography (AS-OCT). Patient and Clinical Findings: A 65-year-old woman underwent cataract surgery. Poor pupillary dilation (5 mm) was noted, and the surgeon opted for a high-density cohesive–dispersive ophthalmic viscosurgical device (OVD) to induce viscomydriasis. The capsulorhexis was performed near the pupillary margin, and an intraocular lens (IOL) targeted to emmetropia was implanted. On postoperative day 1, the patient complained of reduced distance visual acuity. Refraction was −2.50 −1.00 × 70; anterior chamber depth (ACD) was reduced, and the edge of the capsulorhexis overlayed the edge of the IOL, which was separated from the posterior capsule by a transparent liquid. Diagnosis, Intervention, and Outcomes: Anterior capsulotomy was performed, which resulted in an ACD increase and less separation between the IOL and the posterior capsule; 1 hour later refraction was −0.50 −1.50 × 70. Serial AS-OCT confirmed the clinical diagnosis and depicted changes in anatomical relationships between referred structures. Conclusions: Early postoperative CBS is a rare complication of cataract surgery. Anterior capsulotomy is a safe option when preservation of the posterior capsule is advisable. Serial imaging with AS-OCT confirms the diagnosis and treatment success.