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





Histology:

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


Treatment:

Nd:YAG Laser Capsulotomy


Image from Rajan Eye Care Hospital

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