Posterior capsule morphology determinants of visual function

Background: This study explores the relative influence of fibrosis and pearl-type posterior capsule opacification (PCO) on visual function. It also examines the relevance of analyzing different central areas of posterior capsule on visual function. Methods: Thirty-eight eyes of 33 patients had their vision tested and posterior capsules photographed digitally. Each patient then underwent Nd:YAG laser capsulotomy. Patients returned 1 week later for repeat vision tests and photography. Analyses of areas of pearls and fibrosis were performed using the EPCO software system. The difference in these values before and after Nd:YAG laser capsulotomy was compared to change in vision for each patient. The effect of analyzing the central 1.5-, 2.5- and 3.5-mm zones was studied. Results: Stepwise multiple linear regression analysis shows that improvements in distance and near acuity are most strongly related to the central 1.5-2.5 mm of fibrosis and the central 3.5 mm of pearls. Improvements in contrast sensitivity are most strongly related to the central 1.5 mm of both fibrosis and pearls. Conclusion: In the assessment of PCO, the location and morphology of opacification correlate with visual function. Central fibrosis and paraxial pearls are important determinants of visual dysfunction.