A 70-year-old presents 2 years after uncomplicated PCIOL surgery with gradual visual decline. Retroillumination shows a posterior capsule opacity with 'bladder cells' (Elschnig pearls) centrally. What is the posterior capsule opacity (PCO) caused by, and what is the treatment?

• A IOL optic capture into the capsular bag; treated with IOL exchange
• B Deposition of calcium phosphate crystals on the IOL optic; treated with IOL polishing
• C Anterior capsule fibrosis contracting over the IOL; treated with anterior Nd:YAG capsulotomy
• D Epithelial-mesenchymal transformation of residual lens epithelial cells migrating onto the posterior capsule; treated with Nd:YAG capsulotomy ✓

Explanation

Posterior capsule opacification (PCO) or 'after-cataract' is caused by residual lens epithelial cells (LECs) on the equatorial and anterior capsule undergoing epithelial-mesenchymal transformation and migrating posteriorly, producing the 'bladder cell' (Elschnig pearls) appearance when they proliferate onto the posterior capsule. The definitive treatment is Nd:YAG laser posterior capsulotomy, which vaporises the posterior capsule centrally, restoring visual axis clarity. Square-edged IOL optics create a 'barrier effect' that reduces PCO.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.