A patient develops posterior capsule opacification (PCO) 18 months after uncomplicated phacoemulsification with a PMMA IOL. Visual acuity drops to 6/36. The treatment of choice and the expected mechanism of action is:

• A YAG laser anterior capsulotomy — opens the anterior capsule to clear visual axis
• B Surgical capsulotomy through a paracentesis under topical anaesthesia
• C YAG laser posterior capsulotomy — creates a central opening in the opacified posterior capsule ✓
• D Topical corticosteroids to reduce capsule inflammation

Explanation

Posterior capsule opacification (PCO), also called 'secondary cataract,' results from proliferation and migration of residual lens epithelial cells onto the posterior capsule, forming a fibrous or Elschnig's pearl type opacity that reduces vision. Nd:YAG laser posterior capsulotomy creates a precise central opening in the opacified posterior capsule, immediately restoring visual clarity. It is the standard non-invasive outpatient treatment. YAG anterior capsulotomy would be for anterior capsular contraction/phimosis. Surgical capsulotomy is reserved if YAG is contraindicated. Topical steroids have no effect on PCO.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.