Bilateral Asymmetrical Presentation of Dead Bag Syndrome: A Case Report

Delayed complications after uneventful cataract surgeries may arise, including IOL (Intraocular Lens) dislocation. Among the rarest etiologies is Dead Bag Syndrome (DBS), a condition defined by the presence of a clear, transparent capsular bag accompanied by spontaneous posterior capsular rupture (PCR) occurring many years after cataract surgery. This late-onset PCR represents the most distinctive clinical feature of the syndrome.

We report a case of healthy 69-year-old male presented to our Emergency Room (ER) complaining of sudden onset painless decreased vision in the left eye for 2 weeks. He has undergone uneventful cataract surgeries in both eyes. On examination, his uncorrected visual acuity (VA) in the right eye was 20/25 and in the left eye was 20/300. Slit-lamp Examination of the right eye showed vitreous prolapse in the anterior chamber, the IOL was in-situ, however, there was a central PCR. Fundus exam for the right eye was unremarkable. Examination of the left eye showed vitreous prolapse in anterior chamber, and the patient was aphakic with a central PCR. Fundus exam of the left eye showed healthy flat retina with a dislocated IOL. Patient underwent a successful Pars Plana Vitrectomy (PPV) + secondary IOL implantation with excellent visual outcome.

In conclusion, this case illustrates a rare bilateral manifestation of DBS and provides additional insight to this condition. It reinforces the importance of long-term postoperative monitoring and supports the recognition of DBS as a distinct pathological entity. With appropriate evaluation and tailored surgical intervention, satisfactory visual outcomes can be attained despite substantial capsular compromise.