Late-Onset Capsular Block Syndrome with Pupillary Block Angle Closure after Cataract Surgery with Posterior Chamber Intraocular Lens Implantation: A Case Report.

Introduction: Pseudophakic pupillary block angle-closure glaucoma is an uncommon complication following uneventful cataract surgery with posterior chamber intraocular lens (IOL) implantation. Interestingly, capsular block syndrome (CBS) has been reported as another plausible cause of pseudophakic pupillary block angle-closure glaucoma, especially in the early postoperative period. Unlike early postoperative CBS, late postoperative CBS is not associated with a shallow anterior chamber, myopic shift, or elevated intraocular pressure. We report a case of late postoperative CBS presenting with an acute-onset pupillary block angle-closure attack occurring 13 years after uneventful cataract surgery with posterior chamber IOL implantation, which has not been reported in the literature.

Case presentation: An 87-year-old male diagnosed with pseudoexfoliation syndrome developed pseudophakic pupillary block following uneventful cataract surgery with posterior chamber IOL implantation. Late-onset CBS has been identified as the underlying cause of the pupillary block. The combination of zonular laxity observed in pseudoexfoliation syndrome and the presence of a Soemmering ring are potential predisposing factors for this condition. After performing laser peripheral iridotomy (LPI) followed by Nd: YAG capsulotomy, the pupillary block was resolved and vision was improved.

Conclusion: CBS should be considered as a potential cause of pseudophakic pupillary block, even in the late postoperative period. The management of late-onset CBS accompanied by pupillary block angle-closure glaucoma typically includes LPI to eliminate the pupillary block, followed by Nd: YAG capsulotomy.