What are the extracapsular (outside the capsule) warning signs?

From the Guidelines

Extracapsular warning signs include decrease in visual acuity, eye pain, and conjunctival injection, which can indicate potential complications such as cystoid macular edema, retinal detachment, inflammation, or infection following cataract surgery, specifically extracapsular cataract extraction (ECCE) procedure 1.

• A decrease in visual acuity may signal the presence of postoperative complications, and eye pain and conjunctival injection can be indicative of inflammation or infection, requiring prompt medical attention.
• The presence of these warning signs necessitates a thorough evaluation to determine the underlying cause and initiate appropriate treatment to prevent long-term vision loss.
• Other potential complications of ECCE include capsular bag distension syndrome, increased IOP, retinal detachment (RD), corneal abrasion, iritis, vitritis, damage to the IOL, persistent floaters, and dislocation of the IOL 1.
• Patients with high-risk factors, such as axial myopia, pre-existing vitreoretinal disease, male gender, young age, vitreous prolapse into the anterior chamber, and spontaneous extension of the capsulotomy, should be educated about the symptoms of retinal tears or detachment to facilitate early diagnosis 1.
• The surgical technique of refractive lens exchange, which is similar to cataract surgery, should consider special conditions such as high axial myopia, short hyperopic eyes, and high axial length to minimize complications 1.

From the Research

Extracapsular Warning Signs

• Decreased visual acuity, glare, and sensitivity to light are common complaints associated with extracapsular cataract extraction 2
• Extracapsular spread (ECS) in cervical lymph nodes is a significant adverse prognostic indicator in oral squamous cell carcinoma (OSCC) 3
• ECS is associated with a higher incidence of local recurrence, distant metastases, and regional failure in OSCC 3
• The capsular enhancement sign (CES) on dynamic contrast-enhanced prostate multiparametric MRI is a highly specific predictor of extracapsular extension (ECE) in prostate cancer 4
• Tumor capsular contact length is a moderately useful sign of extracapsular extension at endorectal multiparametric prostate MR imaging 5

Prognostic Indicators

• ECS is an independent predictor of poor prognosis in OSCC, with a 5-year overall survival of 19% in patients with macroscopic ECS and 31% in patients with microscopic ECS 3
• The presence of ECS is associated with a higher risk of local recurrence, distant metastases, and regional failure in head and neck squamous cell carcinoma (HNSCC) 6
• The level of extension of ECS is directly correlated with poor prognosis in HNSCC 6

Diagnostic Criteria

• Standardized diagnostic and grading criteria for ECS are still lacking 6
• The imaging modality of choice for diagnosing ECS is a matter of debate 6
• The capsular enhancement sign (CES) on dynamic contrast-enhanced prostate multiparametric MRI has high specificity and positive predictive value for ECE detection 4