A patient develops posterior capsular opacification (PCO) 18 months after uncomplicated phacoemulsification with implantation of a hydrophobic acrylic IOL. The visual acuity has dropped from 6/6 to 6/18. The treatment of choice and the mechanism of improvement is:

• A Repeat phacoemulsification to remove opacified posterior capsule
• B Argon laser photocoagulation of the Elschnig pearls
• C Corticosteroid injection into the posterior chamber to lyse the pearls
• D Nd:YAG laser posterior capsulotomy creating an opening in the opacified capsule ✓

Explanation

PCO results from residual lens epithelial cells (LECs) migrating onto the posterior capsule and proliferating — anterior epithelial cells form fibrous plaques (fibrosis type), while equatorial cells produce bladder cells/Elschnig pearls (regenerative type). Nd:YAG laser posterior capsulotomy creates a central opening in the opacified capsule using photodisruption, instantly restoring the visual axis. It is a definitive, office-based procedure with minimal risk. Complications include IOP spike, IOL pitting, and rare RRD.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.