After Cataract

After cataract. It is also known as ‘secondary
cataract’. It is the opacity which persists or develops
after extracapsular lens extraction.
Causes. (i) Residual opaque lens matter may persist
as after cataract when it is imprisoned between the
remains of the anterior and posterior capsule,
surrounded by fibrin (following iritis) or blood
(following hyphaema). (ii) Proliferative type of after
cataract may develop from the left-out anterior
epithelial cells. The proliferative hyaline bands may
sweep across the whole posterior capsule.
Clinical types. After cataract may present as
thickened posterior capsule, or dense membranous
after cataract (Fig. 8.28A) or Soemmering’s ring which
refers to a thick ring of after cataract formed behind
the iris, enclosed between the two layers of capsule
(Fig. 8.28B) or Elschnig’s pearls in which the
vacuolated subcapsular epithelial cells are clustered
like soap bubbles along the posterior capsule
(Fig. 8.28C).

Treatment is as follows :
i. Thin membranous after cataract and thickened
posterior capsule are best treated by YAG-laser
capsulotomy or discission with cystitome or
Zeigler’s knife.
ii. Dense membranous after cataract needs surgical
membranectomy.
iii. Soemmering’s ring after cataract with clean central
posterior capsule needs no treatment.
iv. Elschnig’s pearls involving the central part of
the posterior capsule can be treated by YAGlaser
capsulotomy or discission with cystitome.