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Finding pearls!

Elschnig’s Pearls

Posterior capsule opacification is the most common complication of cataract surgery.

Lens Epithelial Cells → Migration → Proliferation → Differentiation

Two types of PCO:

Fibrous Abnormal proliferation of LEC → presents as wrinkles and folds on the posterior capsule site at the fusion of anterior and posterior capsules

Proliferative → Elsching’s Pearls

  • Elsching’s Pearls result from aberrant attempts by lens cells attached to the capsule to form new lens fibres

  • Normally differentiated LEC that line the equatorial lens region migrate and proliferate between posterior capsule and the IOL

  • Clusters of residual LEC appear as round, clear pearls that shine on retro-illumination → Appearance of a bunch of grapes/ soap bubbles/ mass of fish eggs

  • Decreased visual acuity if they accumulate on visual axis


Large clear lens cells (bladder cells) are seen behind iris, pupillary space or both areas


Nd:YAG Laser Capsulotomy

Image from Rajan Eye Care Hospital

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