Delayed-Onset Fibrotic Capsular Bag Distension Syndrome

Capsular bag distension syndrome (CBDS) is an uncommon complication of cataract surgery following in-the-bag posterior chamber intraocular lens (PCIOL) implantation. It is characterized by the accumulation of turbid fluid between the IOL optic and the posterior capsule, frequently resulting in reduced visual acuity and a myopic refractive shift. The late-onset fibrotic variant is particularly rare and may manifest several years after otherwise uneventful surgery. A 52-year-old man presented with progressive visual blurring 10 years after uncomplicated phacoemulsification with in-the-bag PCIOL implantation. Slit-lamp biomicroscopy demonstrated turbid fluid trapped between the IOL optic and the posterior capsule. Anterior segment optical coherence tomography confirmed the diagnosis of CBDS. Neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy resulted in immediate evacuation of the accumulated fluid; however, a persistent retrolenticular space and residual myopic shift were observed. In conclusion, very-late-onset fibrotic CBDS should be considered in patients presenting with unexplained refractive changes or retro-IOL fluid accumulation years after cataract surgery. This case underscores an unusually delayed presentation occurring a decade postoperatively. The persistent myopic shift suggests incomplete refractive reversibility, which is typically expected following Nd:YAG laser capsulotomy. This sustained refractive alteration is most plausibly attributable to the continued presence of a retrolenticular space, secondary to retained temporal cortical material, which maintained capsular bag patency despite successful drainage of the turbid fluid.