Posterior capsular opacification <ul><li>Also known as After cataract or Secondary cataract </li></ul><ul><li>Refers to opacity that follows extracapsular cataract extraction </li></ul>
Mechanisms of PCO formation <ul><li>Cortical remnants following cataract surgery- may form a thin membrane overlying the capsule- “membranous” </li></ul><ul><li>Cortical fibres trapped between the anterior and posterior capsules along with formation of abortive opaque lens fibres formed from cubical cells underlying anterior capsule- form a dense ring behind the iris- “Soemmering’s ring” </li></ul>
<ul><li>Proliferation of subcapsular cells to form large balloon like cells which fill the pupillary aperture- “Elschnig’s pearls” </li></ul>
Factors influencing PCO formation <ul><li>AGE: > in younger patients (increased fibrous proliferation) </li></ul><ul><li>Surgical procedure: Phacoemulsification with “in the bag” IOL implantation has lesser risk </li></ul><ul><li>Type of IOL used: </li></ul><ul><li>PMMA and hydrophilic acrylic IOLs: greater risk </li></ul><ul><li>Hydrophobic acrylic and newer generation silicone IOLs with square edges: lesser chance </li></ul><ul><li>Implantation of Capsular Tension Ring: lesser risk </li></ul><ul><li>Duration following surgery: Usually develops a few months following surgery. Rare to develop >5 yrs after surgery </li></ul>
Treatment <ul><li>Thin membranous after cataract /thickened posterior capsule and Elschnig’s pearls: Nd YAG capsulotomy </li></ul><ul><li>Dense membranous as in children: discission using Ziegler’s knife or using vitreous cutter. Thicker non-pliable membranes may require membranectomy using vitreous scissors before they can be aspirated into cutting port </li></ul><ul><li>Soemmering’s ring with clear central PC: no treatment needed </li></ul>
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