Capsular bag distention syndrome
B. Perform posterior capsulotomy with Nd:YAG laser
The key to diagnosis is recognizing hyperdistention of the capsular bag with a turbid milieu posterior to the IOL (Figure 1) along with a myopic shift. Anterior segment OCT confirmed the diagnosis. Performing a posterior capsulotomy would allow egress of the turbid material into the vitreous cavity and provide immediate resolution of the refractive change with minimal risk. If this was not successful, we would then perform a posterior capsulotomy during pars plana vitrectomy (choice A). Exchanging the IOL (choice C) is not preferred because decreasing the new lens power to compensate for the myopic shift would result in a hyperopic surprise, as the procedure itself would resolve the capsular bag distention syndrome (CBDS). Observation (choice D) is preferable when the patient does not want intervention; however, the myopic shift needs to be corrected with an updated manifest refraction.