Natural evolution of Elschnig pearl posterior capsule opacification after posterior capsulotomy

Abstract

Purpose: To study the natural evolution of Elschnig pearl posterior capsule opacification (PCO) after neodymium:YAG posterior capsulotomy. Setting: Instituto Oftalmológico Murciano, Murcia, Spain. Methods: This prospective study comprised 173 eyes that had a posterior capsulotomy to treat Elschnig pearl PCO. Patients were included in the study at different stages after posterior capsulotomy and followed using serial anterior segment photographs for 18 to 48 months. Results: During the first year after the capsulotomy, pearls proliferated and migrated toward the capsulotomy edge in 83% of the cases, leading to the formation of a collar-like ring of pearls around the capsulotomy. During the second year, an increase in cells was observed in 45% of cases; in 45% of eyes, there were fewer pearls. The amount of pearls decreased in 48%, 52%, and 26% of cases at 3, 4, and 5 years, respectively, and were completely gone in 6%, 17%, and 45%. After 5 years, 17% of eyes had a reduction in pearls and 67% had no pearls. Conclusions: Elschnig pearl PCO is a self-limiting process. After posterior capsulotomy, cells proliferated and attempted to occlude the capsular opening. Later, a reduction in the amount of cells was observed, leading to a completely clear posterior capsule in most eyes.