Capsular block syndrome (CBS) is a rare complication of cataract removal.1, 2 It is categorized into three types depending on the time of onset: intraoperative, early postoperative, and late postoperative.3 Late postoperative CBS is typified by the accumulation of a milky-white liquefied substance between the IOL and posterior capsule and capsular bag distention.4, 5 Possible treatments include neodymium:YAG (Nd:YAG) laser capsulotomy6 or surgical lysis of adhesions. Scheimpflug imaging has shown advantages in detecting changes in the anterior segment caused by CBS.7, 8 We present clinical findings in three cases with ultra-late postoperative CBS.
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A 66-year-old man presented with blurry vision in the left eye lasting 5 months. He had undergone phacoemulsification with IOL (Sensar AR40e; Abbott Medical Optics Inc., Santa Ana, CA, USA) implantation in the left eye 12 years earlier. His best-corrected visual acuity during the early postoperative stages was 20/20. At presentation, slit lamp (Figure 1a) and Pentacam (Figure 1b) examinations demonstrated CBS in the left eye. After laser capsulotomy, capsular bag distension was resolved.
Capsular bag extension and fibrosis of the capsulorhexis margin were evidently observed in our cases. Late postoperative CBS has been described as liquefied after-cataract13 with remarkable posterior capsule distention filled with milky-white, opaque fluids. It contains proteinaceous products of residual lens epithelial cells (LECs),14 producing extracellular matrix and leading to fibrosis. Substances trapped within the capsular bag cause an increase in osmotic pressure and trigger chronic fluid accumulation. The blurring and occlusion of vision caused by opacities and myopia induced by the gradual distension of the capsule finally lower the quality of the visual outcome. With the assistance of Pentacam imaging, Case 3 was presented as a good example of ultra-late CBS, with the coexistence of residual lens material, PCO, and liquefied products (Figure 1i), indicating a possible relationship between the proliferation of LECs, fibrosis, and subsequent liquefaction. Residual LECs of the cortex are not only the reason for PCO but also the source of the milky-white substance,15 and late CBS is most likely a process involving PCO and liquefaction.
Late postoperative capsular block syndrome and intraocular lens opacification. (a) Anterior segment photos of an opacified intraocular lens case before pupil dilation. (b) Anterior segment photos of an opacified intraocular lens case after pupil dilation. (c) Comparison of late postoperative capsular block syndrome and intraocular lens opacification.
The aim was to evaluate whether using novel anchored barded suture for capsular closure can further shorten the length of stay following primary total knee arthroplasty (TKA) within existed enhanced recovery after surgery (ERAS) protocol in osteoarthritis patients.
The use of barded suture for capsular closure was associated with shorter length of stay after TKA compared to traditional suture, suggesting that barded suturing technique could be one effective intervention for ERAS.
The novel anchored barbed suture for capsular closure was associated with a shorter hospital length of stay in patients receiving primary total knee arthroplasty. Even with the ERAS programs, the average operative time and average length of stay of patients with the novel anchored barbed suture were still significantly shorter.
Anterior capsular phimosis is the centripetal fibrosis and contraction of the capsulorhexis after cataract extraction. Individuals with zonular laxity are at increased risk for this condition. Mild to moderate amounts of phimosis are usually not visually significant, but severe cases may require treatment by Nd:YAG laser anterior capsulotomy.
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A 72-year-old Asian man complained of decreased visual acuity 5 years after undergoing phacoemulsification with posterior chamber lens implantation. Under slit-lamp examination, late postoperative capsular block syndrome was diagnosed and Nd:YAG laser anterior capsulotomy was performed. Ten months after anterior capsulotomy, the patient returned with decreased visual acuity and was diagnosed with recurrent fibrotic capsular block syndrome. Nd:YAG laser posterior capsulotomy was performed.
In this case, we performed Nd:YAG laser anterior capsulotomy. It is difficult to focus on the posterior capsule while performing Nd:YAG laser posterior capsulotomy for late-onset CBS without PCO because of the opacity of the capsular bag contents and IOL vaulting. Furthermore, some people complain of floaters [15], and other complications, such as cystoid macular edema, severe inflammation, increased intraocular pressure or retinal detachment, have been reported after Nd:YAG laser posterior capsulotomy [16]. In some reports, Nd:YAG laser anterior capsulotomy was chosen as the primary treatment for late postoperative CBS [4, 13, 15]. We prefer anterior capsulotomy as a first line treatment for late-onset CBS without PCO. When PCO is present, we prefer to perform posterior capsulotomy. If posterior capsulotomy is not feasible owing to technical reasons, anterior capsulotomy followed by immediate laser posterior capsulotomy can be an alternative treatment.
CBS, capsular block syndrome; CCC, continuous curvilinear capsulorhexis; IOL, intraocular lens; IOP, intraocular pressure; LECs, lens epithelial cells; Nd:YAG, neodymium-yttrium-aluminum-garnet; PCO, posterior capsule opacification; UCVA, uncorrected visual acuity
Ruffini, Pacinian and Golgi tendon organ mechanoreceptors have been reported in the hip joint capsular tissue of individuals with OA and other pathologies [28, 49, 58]. Some of this research did not specify which individuals expressed mechanoreceptors, thus preventing comparison between pathologies [58].
A greater density of Pacinian and Ruffini corpuscles appear to be present in the hip capsules of both healthy individuals [28] and patients with OA [28, 49] compared to other mechanoreceptors. These mechanoreceptors act to monitor vibration and tensile loading, respectively. However, it is unclear if individuals have more Pacinian or Ruffini corpuscles in their hip capsular complex. When comparing the changes in density of specific mechanoreceptors in the hip capsules of those with and without OA Pacinian corpuscles are more greatly reduced in the OA group compared to the healthy group than the reduction in Ruffini corpuscles [28]. This may have an effect on biomechanical functioning of the joint, but more research is required to confirm this.
Fewer FNEs appear to be present at the periphery of the capsule of individuals with various pathologies (AVN, CO, FAI, OA, SHD) compared to the medial and lateral aspects [48]. These findings are different to findings reported in subjects with no known pathology [43]. However, these studies may not be directly comparable as different regions of the capsule are investigated, resulting in the distribution of FNEs in the capsular complex still being unclear.
A coherent map of the innervation of the hip capsule with respect to anatomical location, sex, age, and pathology is lacking. Many variables differ concurrently and therefore it is difficult to compare the different studies. Increased proprioceptive and nociceptive function may be present superior-laterally compared to other regions. This indicates that lower dislocation rates and post-operative pain may result from THA which repairs the capsule in the superior-lateral region or spares this region by employing a different approach. Furthermore, less post-operative pain may result from maintaining the normal capsular tissue and its innervation. In addition, a relationship may be present between age and nerve distribution, indicating that different techniques may be required during THA in the elderly population. However, further research is required to understand post-operative innervation following THA with and without repair of the capsule. Despite the literature noting the presence of mechanoreceptors in the capsule, research employing immunohistochemical methodologies have not been successful in identifying mechanoreceptors, to date. Conventional histological stains are thought to only highlight morphologically normal mechanoreceptors, which may result in underprediction of proprioceptive function. Further research is required employing suitable immunohistochemical techniques, in order to determine the proprioceptive role of the hip capsule and its contribution to the function of the hip joint. 2ff7e9595c