Posterior capsule opacification (PCO) following cataract surgery is
the manifestation of the migration and proliferation of lens epithelial cells
on the posterior capsule. When PCO encroaches onto the visual axis, it causes
light scatter and deterioration of vision. This condition is usually treated
by a posterior capsulotomy with a Nd:YAG laser. There is a rare case, however,
of a patient who had spontaneous regression of PCO from Elschnig pearl proliferation,
with improvement of visual acuity.1 We report
a similar case of spontaneous Elschnig pearl regression taking place throughout
In November 1997, a 75-year-old man visited us with blurred vision in
his right eye, 3 years after cataract surgery. Cataract surgery was performed
by a local physician in 1994, and the details of the operation were unknown.
He had been treated with oral medication for hypertension and arrhythmia.
Other medical history was unremarkable.
On examination, a single-piece polymethylmethacrylate intraocular lens
(IOL) was seen in the posterior chamber and was associated with marked Elschnig
pearls reaching the central region of the posterior capsule (Figure 1, A). Seemingly, the surgery had been performed using phacoemulsification
with a "can opener" capsulotomy. The site of IOL implantation (inside or outside
of the bag) could not be confirmed. No apparent operative complications were
found. Despite the symptom of blurred vision, the patient's visual acuity
was 20/15 OD with −0.75 diopters (D), and thus, a posterior capsulotomy
was not performed.
A, Marked Elschnig pearls reaching the visual axis are seen in November
1997. B, Elschnig pearls significantly and spontaneously regressed in August
2000. The posterior capsule was intact. C, Parts of Elschnig pearls (arrow)
showed a swing on eye movements. D, One month later, this portion disappeared
In August 2000, he returned after the interval of 3 years with decreased
vision in his left eye that was diagnosed as cataract. Slitlamp examination
revealed that Elschnig pearls of the right eye significantly decreased (Figure 1, B). In particular, those behind
the IOL optic disappeared almost completely. The posterior capsule was intact.
The patient had not received any surgical, laser, or medical treatments for
the right eye since the last visit. Corrected visual acuity was 20/15 with −1.0
D. The patient gave no report of blurred vision in his right eye. There was
In October 2000, parts of Elschnig pearls showed a swing on eye movements
(Figure 1, C). One month later, this
portion disappeared completely (Figure 1, D).
The fellow left eye underwent phacoemulsification and implantation of
a silicone IOL within the capsular bag in August 2000. There was no pseudoexfoliation
and phacodonesis. Postoperatively, neither development nor regression of PCO
has been observed in this eye until now.
Spontaneous regression of Elschnig pearls is very rare.1
This is partly because significant PCO is usually treated by the Nd:YAG laser
immediately when recognized. In this case, despite the blurred vision, the
corrected visual acuity happened to remain at 20/15 OD, and the patient could
manage well with that acuity, allowing for the observation of the long-term
There has been a reported case of spontaneous improvement in visual
acuity after PCO,2 but it was related to
the displacement of a dense central area of Elschnig pearls by the progressive
capsule contraction from fibrosis. Caballero et al3
reported several cases of spontaneous disappearance of Elschnig pearls after
a Nd:YAG laser capsulotomy. Hollick et al4
demonstrated that lens epithelial cells that migrated onto the posterior capsule
in the early postoperative period substantially regressed between 30 and 90
days postoperatively.4 They attributed this
phenomenon to the tight adhesion between the IOL material and capsular bag.
This postulate, however, does not apply to the case presented here because
there was some space between the IOL optic and the posterior capsule as evidenced
by the movement of Elschnig pearls, (Figure 1, C).
It may be that the lack of tight contact between the IOL and the capsule led to the exposure of Elschnig pearls to
the aqueous humor, resulting in the drop-off of loosened and inactive cells
from the posterior capsule.
None of the authors has a proprietary or financial interest in any product
Corresponding author and reprints: Tetsuro Oshika, MD, Department
of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku,
Tokyo 113-8655, Japan (e-mail: firstname.lastname@example.org).
M Spontaneous regression of Elschnig pearl posterior capsule opacification. J Cataract Refract Surg.
2000;26779- 780Google ScholarCrossref
D Spontaneous visual improvement in the presence of posterior capsule
opacification. Aust N Z J Ophthalmol.
1992;2065- 67Google ScholarCrossref
JM Spontaneous disappearance of Elschnig pearls after neodymium:YAG laser
posterior capsulotomy. J Cataract Refract Surg.
1997;231590- 1594Google ScholarCrossref
MV Lens epithelial cell regression on the posterior capsule with different
intraocular lens materials. Br J Ophthalmol.
1998;821182- 1188Google ScholarCrossref