ABSTRACT

Opacification of the posterior capsule caused by postoperative proliferation of cells in the capsular bag remains the most frequent complication of cataract surgery. In addition to classic posterior capsule opacification (PCO), postoperative lens epithelial cell (LEG) proliferation is also involved in the pathogenesis of other entities. These include anterior capsule opacification (ACO) and interlenticular opacification (ILO); a more recently described complication related to piggyback IOLs. Thus, there are three distinct anatomic locations within the capsular bag where clinically significant opacification may occur postoperatively (Fig. 53.1). In this chapter we will discuss the etiopathogenesis, clinical manifestations, pharmacological, surgical as well implant related factors for prevention of the PCO. Interested readers may consult the published articles for other modalities of capsular bag opacification including ACO and ILO.1,10-12,88,89,92,95-98,101-104

POSTERIOR CAPSULE OPACIFICATION (SECONDARY CATARACT)

BACKGROUND AND SIGNIFICANCE

Posterior capsule opacification (PCO, secondary cataract) has been recognized since the origin of extracapsular cataract surgery (ECCE) and was noted by Sir Harold Ridley in his first intraocular lens (IOL) implantations.3,8 It was particularly common and severe in the early days of IOL surgery when the importance of cortical clean-up was less appreciated. Through the 1980s and early 1990s, the incidence of PCO ranged between 25-53 percent.7,8

Improvements in cataract surgical technique have led to a gradual, but steady, decrease in the incidence of this complication. Our data show that through a combination of modern techniques and IOL designs, the incidence of Nd: YAG laser posterior capsulotomy is now decreasing into single digits.4-6,78-80

WHYTO ERADICATE PCO?