A patient has undergone uncomplicated phacoemulsification with IOL implantation 4 weeks ago. He now presents with gradually decreasing vision. Slit-lamp examination shows Elschnig's pearl-like opacification of the posterior capsule. This complication results from:
- A Fibrous metaplasia of residual anterior lens epithelial cells migrating to the posterior capsule
- B Proliferation and migration of residual equatorial (E-type) lens epithelial cells onto the posterior capsule, undergoing aberrant lentoid formation (Elschnig pearls) ✓
- C Posterior migration of the IOL optic against the posterior capsule
- D Inflammatory fibrin deposition on the posterior capsule surface
Correct answer: B. Proliferation and migration of residual equatorial (E-type) lens epithelial cells onto the posterior capsule, undergoing aberrant lentoid formation (Elschnig pearls)
Explanation
Posterior capsule opacification (PCO) causing Elschnig pearls results from proliferation and anterior-to-posterior migration of equatorial (E-type) lens epithelial cells from the lens equator and anterior subcapsular epithelium. These cells undergo aberrant differentiation, forming large vacuolated balloon cells (Elschnig pearls) on the posterior capsule. The fibrous/wrinkled type of PCO is from anterior epithelial cells undergoing epithelial-mesenchymal transition. Treatment is YAG laser posterior capsulotomy.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.