1. Authors have no any financial interest in the subject matter
Retrospective analyses of the capsular block formation in patients with cataract and pseudoexfoliation syndrome
Ophthalmological department, State Institution "Zaporizhzhya Medical Academy of Postgraduate Education Ministry of Public Health of Ukraine
N. Lutsenko, PhD,
O. Isakova, MD,
O. Rudycheva, MD
Authors have no any financial interest in the subject matter

2. Introduction to the problem
Capsular block syndrome (CBS) is a unique and rare complication of cataract surgery, which occurs in different time ( intraoperative, postoperative).
 Pseudoexfoliation (PXE) is a common and clinically important systemic condition that can cause serious complications during cataract surgery due to the pupilary rigidity and zonular weakness and instability.
Intraoperative capsular block -  iris prolapse, shallowing of the anterior chamber, ocular pressure increasing after the hydrodissection 
postoperative capsular block - anterior chamber shallowing, anterior displacement of the IOL, unexpected myopic over-refraction

3. The age of the patients was between 60 and 89 years.
Purpose - to study the frequency and reasons of capsular block formation during cataract surgery or in postoperative period in patients with cataract and pseudoexfoliation syndrome (PXE)
In all cases phacoemulsification was performed by one surgeon through 2.25 mm clear corneal incision.
The viscoelastic materials used included sodium hyaluronate, 3%-chondroitin sulfate 4% (Viscoat®, Alcon) and 1.4% sodium hyaluronate (Hyaral, Ukraine ).
The IOL was implanted into the capsular bag.
The age of the patients was between 60 and 89 years.
The pseudoexfoliation diagnostic was based on the biomicroscopic observation of the PEX material in the pupil edge or lens

4. Material and method
Retrospectively were analyzed 400 eyes ( 320 patients) with cataract and PXF
Mean age 73,6±6.6
Pupil diameter after dilatation
Poor
2-4 mm
Moderate
4-5 mm
Good
5.5-6 mm
64 eyes
142 eyes
194 eyes
According to the pupil size the continuous curvilinear capsulorhexis (CCR) size ranged from 4.5 to 5.5 mm

5. Results Intraoperative capsular block syndrome
occurred at 4 eyes (1 %) with poor
( 3 eyes) and moderate (1 eye) mydriasis
Postoperative capsular block syndrome (CBS) occurred at 9 eyes (2.2 %) with poor (3 eyes) or moderate (5 eyes) pupil dilatation.
Postoperative CBS was resolved spontaneous in 2 weeks at 5 patients with the use of hypotensive therapy. YAG laser capsulotomy ( anterior or posterior) was performed at 4 patients.
In all cases of CBS IOL implantation was made in the presence of a small (4.0–4.5 mm) anterior CCR

6. Summary
CBS developed in all patients with rigid pupil, depends on the accumulation of a liquefied substance inside the capsular bag, due to capsulorhexis block by the lens nucleus (during phacoemulsification) or posterior chamber IOL
(in postoperative period).
Preventive measures include performing adequate size of anterior capsulorhexis, great caution of hydrodissection, depressing the posterior lip of the incision and complete removal of the OVD from the capsular bag after IOL implantation