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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.

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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