Late Postoperative Capsular Bag Distension Syndrome Presenting 15 Years After Surgery Successfully Treated With Neodymium-Doped Yttrium Aluminum Garnet Posterior Capsulotomy

A 74-year-old man presented with progressively worsening hazy vision in his right eye 15 years after cataract surgery. He had previously undergone an unsuccessful neodymium-doped yttrium aluminum garnet (Nd:YAG) posterior capsulotomy elsewhere for presumed posterior capsule opacification. Slit lamp examination revealed yellow turbid fluid distending the capsular bag behind the intraocular lens with posterior bowing of the posterior capsule, consistent with late postoperative capsular bag distension syndrome. No significant anterior chamber inflammation was observed. A repeat Nd:YAG posterior capsulotomy was performed using an Abraham lens, resulting in immediate decompression of the capsular bag. The intraocular lens remained well centered, and the patient reported marked subjective visual improvement. Late postoperative capsular bag distension syndrome is an uncommon and often misdiagnosed cause of delayed visual decline after cataract surgery. Recognition of its characteristic slit lamp findings is essential, and Nd:YAG posterior capsulotomy remains a safe and effective treatment, even many years after the initial surgery.