A 65-year-old diabetic patient undergoes uneventful phacoemulsification and in-the-bag IOL implantation. At 3 months post-operatively, vision drops to 6/36. Slit-lamp examination reveals a thick, opaque posterior capsule with proliferating lens epithelial cells (Elschnig's pearls). The most appropriate treatment and its mechanism is:
- A Surgical membranectomy through pars plana vitrectomy
- B Topical steroids to dissolve lens epithelial cell proliferation
- C Nd:YAG laser anterior capsulotomy to clear the visual axis
- D Nd:YAG laser posterior capsulotomy — creates an opening in the opacified capsule ✓
Explanation
Posterior capsule opacification (PCO) — the most common complication of cataract surgery — is caused by residual lens epithelial cells that migrate to the posterior capsule and undergo fibrous or pearl-type (Elschnig's pearls) metaplasia. The definitive treatment is Nd:YAG laser posterior capsulotomy, which uses photodisruption to create a clear central opening in the opacified capsule, immediately restoring the visual axis. Surgical membranectomy is reserved for cases where Nd:YAG is contraindicated or unsuccessful. Topical steroids have no role in dissolving lens epithelial cell proliferation. Anterior capsulotomy would not address the posterior capsule.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.