Posterior Capsule Opacification: An Overview

DOS Times Vol. 12, No. 4 October, 2006 Posterior capsule opacification (PCO) and posterior chamber intraocular lens (PC IOL) decentration still remain two major complications of successful extracapsular cataract surgery (ECCE) or phacoemulsification. Ridley, who performed the first intraocular lens implantation in 1949, himself noted these complications in his earliest patients.7 In his initial publications, he described lens decentration, and remarking that apparently, the most difficult problem was to retain the lens in position. He also recognized the problem of PCO and designated it as “ the principal complication” that is not easy to treat, and which requires division of posterior capsule i.e surgical posterior capsulotomy.8,9 Control of decentration and PCO is becoming more necessary now that IOL implantation is emerging as a refractive procedure that mandates almost a perfect optical rehabilitation as opposed to the former goal of simply removing the opaque lens material and achieving safe but less than optimal visual rehabilitation. 5 As the cataract operation continues to be perfected, major goal is to eliminate these complications. Clinical studies have reported an incidence varying between 10% 50% of posterior capsule opacification following ECCE or phacoemulsification with PC IOL implantation. 1,2,3,12-15 Schaumberg et al conducted an important metanalysis of published articles on PCO and generated pooled estimate of eyes developing PCO over three postoperative points: 1,3 and 5 years. They noted that even today the rate of PCO remains unexpectedly and unacceptably highstill over 25% during the 5-year postoperative period. 1 Furthermore, adverse clinical sequelae may be associated with Nd:YAG laser posterior capsulotomy. Last but not the least, there are very significant and compelling financial reasons to eliminate the necessity to do Nd:YAG laser capsulotomy. Nd:YAG laser posterior capsulotomy now ranks as the second most expensive surgical cost to the US health care system, second only to the cost of the original cataract operation13.