An after after-cataract: A curious case of visual axis re-opacification

Abstract

Posterior capsular opacification (PCO) is common after cataract surgery. Recurrence is very rare after a successful Yttrium aluminium-garnet (YAG) capsulotomy in adults. We report a case of visual axis re-opacification after a successful YAG capsulotomy for PCO in an adult. A 60-year male underwent phacoemulsification with +20.0 D acrylic hydrophobic intraocular lens implantation and silicon oil removal (SOR) five months after a successful retinal detachment repair. He underwent a capsulotomy after two months of surgery; however, the visual axis re-opacified after three more months. A YAG anterior hyaloidotomy resulted into improved vision which was maintained over further follow-up. In a post-vitrectomy pseudophakic eye, compression by silicon oil on the posterior capsule is lost after SOR, causing easier and faster migration of lens epithelial cells from the equator to the centre forming an early PCO. Recurrence is possible due to the proliferation of lens epithelial cells along anterior hyaloid also. This case highlights the infrequent scenario of visual axis re-opacification and therefore has teaching value for residents and trainee doctors, who should be made aware of this occurrence. Patients should be explained about this possibility when undergoing YAG capsulotomy in complicated cases such as this one.

Keywords: Anterior hyaloid phase opacification; Capsulotomy; Posterior capsular opacification; Visual axis re-opacification.

Figure 1

Slit lamp images showing the sequence of events in the case. (A) Post vitrectomised eye with posterior subcapsular cataract. (B) 2 months postoperative appearance with intraocular lens in situ and evident posterior capsular opacification. (C) Immediate post YAG appearance showing clearance of visual axis. (D) Re-appearance of visual axis opacification due to lens epithelial cell proliferation. (E) Immediate post YAG appearance showing the clearing of visual axis. (F) Post second YAG 6 months clinical picture showing a clear visual axis.

Figure 2

High magnification slit lamp image showing the visual axis re-opacification. Capsulotomy edges can be seen. Lens epithelial cell proliferation and migration centripetally on the anterior hyaloid face is present and it the possible cause of visual axis opacification.