Question

A patient presented to eye OPD after 3 years of cataract surgery. Slit lamp finding was given. What is the likely diagnosis?

• A. PCO
• B. Bullous keratopathy
• C. Phakic glaucoma
• D. Lens subluxation

Hint:

Vision drop years after cataract surgery with a pearly/wrinkled membrane behind the IOL = posterior capsular opacification, treated by Nd:YAG capsulotomy.

Answer 1

The Correct Option is A

Step 1: Note the timing. The patient returns 3 years AFTER cataract surgery with a slit-lamp abnormality. The commonest late complication of cataract surgery (extracapsular cataract extraction / phacoemulsification with an intraocular lens) is Posterior Capsular Opacification (PCO), also called an "after-cataract" or secondary cataract.

Step 2: Why PCO fits the slit-lamp picture. PCO occurs when residual lens epithelial cells proliferate and migrate across the posterior capsule that was left in place to support the intraocular lens. This produces opacities - classically pearl-like Elschnig pearls and wrinkling/fibrosis of the posterior capsule (a "fish-egg" appearance) seen on the slit lamp behind the IOL. It presents months to years after surgery with gradually declining vision and glare, exactly matching the 3-year interval here. It is treated with Nd:YAG laser capsulotomy.

Step 3: Why the other options are wrong. Bullous keratopathy is corneal oedema with epithelial bullae due to endothelial damage; it is a corneal (not capsular) problem and the slit-lamp shows corneal oedema, not capsular pearls. Phakic glaucoma is not a standard diagnosis and would relate to raised intraocular pressure, not a slit-lamp capsular opacity. Lens subluxation implies a displaced lens (e.g. trauma, Marfan), but after cataract surgery the natural lens has been removed and an IOL placed, so this does not fit the classic late post-cataract picture.

Final answer: Option A - PCO (Posterior Capsular Opacification).