Oculase Articles

Can posterior capsule opacification be avoided?

Mr Tariq Ayoub - 12 Aug 2022

Before cataract surgery, you may have heard about the risk of posterior capsular opacification (PCO). You might then wonder if posterior capsular opacification can be avoided.

During this article, we discuss what causes PCO and what your eye specialist (ophthalmologist) might do to try and prevent PCO.


What causes posterior capsular opacification?

Posterior capsular opacification (PCO) is a common complication of cataract surgery. It can occur months or years after the procedure. To learn more about the risks of cataract surgery, read our blog.

During cataract surgery, we replace your natural lens with an artificial lens that sits in your lens capsule. The lens capsule can cloud (opacify) over time, mimicking the signs of a cataract. 

Signs of PCO

  • Misty, cloudy vision
  • Glare from bright lights
  • Blurry or double vision
  • Less able to focus

Other causes of opacification

  • Capsular striae
  • Capsular phimosis
  • Capsular bag distension syndrome


Diagnosing PCO

If we suspect you have posterior capsular opacification, we will ask you questions about your symptoms. We will also examine your eyes and perform a slit lamp examination. Together, this allows us to determine the severity of your PCO and the type.

Types of PCO

The appearance of PCO can differ depending on the type. There are two types of PCO: fibrous and pearl, also known as proliferative. Though, we treat both types the same way. 

Fibrous PCO resembles wrinkles and folds.

Pearl PCO appears as shiny deposits like clear, round pearls.

We may also find a combination of both types.


Can posterior capsule opacification be avoided?

There are multiple ways your ophthalmologist may try to reduce the likelihood of PCO. But, they cannot guarantee that you won’t get posterior capsular opacification. Roughly one in five people get PCO after cataract surgery.

Factors linked to preventing PCO:

  • The material of the lens
  • Any additional devices used
  • Adapting surgical techniques
  • Cleaning the capsular bag effectively
  • The shape of the artificial lens used


The material of the lens

Biocompatibility is important when choosing an artificial lens. If the material is biocompatible, it means it fits well with the living tissue.

Some evidence suggests that silicone lenses are more biocompatible and have lower PCO scores than other materials. On the other end of the scale, hydrogel lenses typically have higher PCO scores.


The shape of the artificial lens

Some lenses show fewer cases of PCO than others. Square-edged lenses, in particular, are the most popular for avoiding posterior capsular opacification. These are also known as sharp-edged IOLs (intraocular lenses). Though, these lenses are associated with dysphotopsia.

Dysphotopsia refers to unwanted images, either positive or negative, such as glares and halos. Your ophthalmologist can discuss the different lens options with you, as well as their risks and benefits.


Cleaning the capsular bag

The capsular bag, or lens capsule, holds the artificial lens in place. By cleaning it effectively, we limit leftover cells, such as lens epithelial cells. Lens epithelial cells can multiply, leading to PCO.


Risk factors of posterior capsular opacification

Some factors, though, are out of your specialist’s control. For example, the age of the patient. Younger patients have higher rates of posterior capsular opacification. Certain conditions can also increase your risk of PCO, such as glaucoma and diabetes.


Treating PCO

PCO won’t disappear on its own. We treat posterior capsular opacification with YAG laser capsulotomy. During YAG, we use a low-energy laser to cut a small section from the back of the lens capsule. Learn how effective YAG is by reading our blog: How effective is posterior capsular opacification treatment?

Watch our video below on how we treat PCO to learn more.


Book an appointment

If you’ve had cataract surgery but feel like your symptoms are returning, you may have posterior capsular opacification. Our ophthalmologist can perform a series of tests to confirm this diagnosis and arrange a YAG laser capsulotomy.

To discover if you have PCO, book an appointment with our expert ophthalmologist. Mr Tariq Ayoub prides himself on delivering the best care for his patients. 

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About the author

Mr Tariq Ayoub
Mr Tariq Ayoub, Consultant Ophthalmologist

Mr Ayoub has been rated as one of the top eye surgeons in the UK. He is a Consultant Ophthalmic Surgeon with Imperial College Healthcare NHS Trust in London, one of the largest NHS trusts in England. He is also the Lead for the Emergency Department at Western Eye Hospital, as part of the Imperial College Trust.

Mr Ayoub completed his Ophthalmology training at the prestigious London School of Ophthalmology, namely at Moorfields Eye Hospital and Royal Free Hospital. During his career, he has received many prestigious awards from national and international organisations for his work in the field of ophthalmology.

His clinical interests include treatment for cataracts, vision correction, corneal disease, eye-lid disorders, trauma, and general ophthalmology. Mr Ayoub prides himself on the high quality of his work. With his extensive experience, he can holistically manage complex eye conditions to deliver the best care for his patients.

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