Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy Michael Georgopoulos, MD, Oliver Findl, MD, Rupert Menapace, MD, Wolf Buehl, MD, Matthias Wirtitsch, MD, Georg Rainer, MD Purpose: To evaluate the influence of a neodymium:YAG (Nd:YAG) laser capsu- lotomy on the morphology and development of regeneratory opacification of the remaining surrounding posterior capsule. Setting: Department of Ophthalmology, Medical School, University of Vienna, Vi- enna, Austria. Methods: Standardized digital retroillumination photographs were taken immedi- ately before and after Nd:YAG laser capsulotomy and at 1 week, 6 months, and 1 to 3 years in 38 eyes of consecutive patients. Changes in regeneratory posterior capsule opacification (PCO) and opacification around the capsulotomy opening were evaluated. The influence of the type of intraocular lens (IOL) material and design (acrylic, n = 8; hydrogel, n = 8; silicone open loop, n = 11; silicone plate haptic, n = 6; poly(methyl methacrylate) [PMMA], n = 5) was assessed. The state of the anterior vitreous surface was examined at the slitlamp in all eyes. Results: In 8 of 17 eyes with a silicone IOL, reduced regeneratory PCO was ob- served. Massive pearl formation on the margin of the Nd:YAG capsulotomy was typical with silicone IOLs (8 eyes) but also occurred with PMMA IOLs. Eyes with acrylic IOLs had no change in regeneratory PCO after the capsulotomy. Three of 8 eyes with hydrogel IOLs had complete closure of the posterior capsulotomy opening. Conclusions: Neodymium:YAG laser capsulotomy induced changes in the devel- opment and morphology of regeneratory PCO. Silicone and PMMA IOLs led to significant pearl formation on the capsulotomy margin, often combined with a re- duction of peripheral regeneratory PCO (silicone). Hydrogel IOLs led to a higher incidence of reclosure of the Nd:YAG capsulotomy opening. J Cataract Refract Surg 2003; 29:1560 –1565 © 2003 ASCRS and ESCRS S econdary cataract, or posterior capsule opacification (PCO), is a major complication of cataract surgery, with a reported incidence of 10% to 50%. 1–3 In cases of vision-impairing PCO, neodymium:YAG laser (Nd:YAG) capsulotomy is the treatment of choice. 4 Complications of capsulotomy include intraocular pres- sure elevation, cystoid macular edema, retinal detach- ment, 5,6 pits on the intraocular lens (IOL), and changes in IOL position. 7 The regeneratory type of PCO is best seen on retroillumination and consists of lens epithelial cells (LECs) originating from the equatorial region. When the LECs grow between the IOL and posterior capsule and are given enough space, they form Elschnig pearls. The natural course from a clear posterior capsule immediately after cataract surgery to significant PCO necessitating Nd:YAG laser capsulotomy is well known. It is also commonly accepted that the incidence of PCO Accepted for publication March 24, 2003. Reprint requests to Michael Georgopoulos, MD, Department of Oph- thalmology, University of Vienna Medical School, Wa ¨hringer Gu ¨rtel 18-20, A-1090, Wien, Austria. E-mail: michael.georgopoulos@akh- wien.ac.at. © 2003 ASCRS and ESCRS 0886-3350/03/$–see front matter Published by Elsevier Inc. doi:10.1016/S0886-3350(03)00345-6