A Classic Case of Dead Bag Syndrome

BY AUSTIN NAKATSUKA, MD, AND KATHERINE HU, MD

Eight years after an uneventful cataract surgery, a 60-year-old patient presented in clinic with complaints of a line through his vision. We noted the lens was inferiorly subluxated and seemed to be loose in the capsular bag.

During surgery, after filling the bag and anterior chamber with viscoelastic, we tested the mobility of the lens, finding it to be freely mobile within the capsular bag.

We easily dialed it out into the anterior chamber with no impediments and found that it behaved similarly to a lens that had just been placed on the original surgery day. We found no obvious damage to the haptics or haptic-optic junction of the lens. After reinspecting the bag, we found no sign of any scar, remnant lens epithelial tissue, or fibrotic changes. The capsular bag looked clearer than we would typically see even a day or two after surgery.

We rotated the lens and removed it in three pieces using micro scissors in an atraumatic fashion. We observed an excellent red reflex through the clear, acellular bag. Of note, the surgeon who had done the initial surgery was very skilled and not known to polish the capsule excessively.

We believed this to be a classic case of dead bag syndrome.

Intraoperatively with a widely dilated pupil, the surgeons noted that the lens was off-centered and appeared to be “floating” in the clear, acellular capsule. The IOL was devoid of abnormalities or notable defects.

To treat, we placed a three-piece sulcus lens with optic capture since the capsular bag appeared to be stable intraoperatively and there were no signs of zonular laxity. We tested the lens and found it to be stable and secure.

There was no instability of the capsular bag, and the lens stayed very well-centered. The patient reported resolution of his symptoms, but we carefully monitored him for lens dislocation.

Some cases of this rare condition will require scleral fixation due to higher rates of zonular instability.

More Information

This article is adapted from “Dead Bag Syndrome: Why You Can’t Just Place a Lens in the Bag,” a video presentation at the 2022 ASCRS Annual Meeting. View the video here. video.

About the Authors

Dr. Nakatsuka specializes in complex cataract surgery, dislocated intraocular lenses, and medical and surgical glaucoma.

Dr. Hu specializes in refractive and cataract surgery, as well as corneal transplants and IOL-related procedures.