PCO a living dynamic process after cataract surgery

Lisbon, Portugal – Posterior capsule opacification (PCO) after cataract surgery is an evolving process, Oliver Findl, MD, from the Medical University of Vienna, Austria, explained Saturday at the European Society of Cataract and Refractive Surgeons.

“To date, little is known about the morphology of PCO and its development,” Dr. Findl said.

He and his colleagues conducted a study in which they observed PCO over the short term (2 to 4 weeks) after surgery. Postcataract patients with PCO who were to undergo YAG capsulotomy were examined several times during 2-week intervals. The investigators found, for example, that initially where there was no Elschig pearl, a pearl had developed, and then disappeared in the space of 2 weeks. Other examples included the appearance of fused pearls, although this remains uncertain, that then disappeared 2 weeks later; in addition, some pearls may divide and others pearls seem to travel, he explained.

“These results were very stunning to us. We had believed that once a pearl developed it persisted for the life of the patient,” he commented.

“We found that in 68% of patients there was a decrease or increase in the number of pearls in a 2-week period. The appearance and disappearance of pearls occur quite commonly without therapy,” Dr. Find said.

“PCO is alive. We have observed progression and progression of PCO pearls that disappear frequently and this may be due to apoptosis or osmotic process; this is still unknown. Whether fusion and division of pearls actually occur is also unknown,” Dr. Findl said. “The lifespan of pearls seems to vary from a few days to weeks or months, and the lifespan varies markedly among patients. There is a need to quantify these changes to be able to analyze vast numbers of pearls.

“We also need to revisit histology and the pathophysiology of PCO to understand the activity of these cells and to determine if they can be influenced. The questions that need to be addressed are the effect of IOL material in the eye and if drugs influence PCO and the morphology,” he stated.

Preliminary studies are under way using prednisolone four times daily for 14 days.