ELSCHNIG PEARL FORMATION ALONG THE POSTERIOR CAPSULOTOMY MARGIN AFTERNEODYMIUM-YAG CAPSULOTOMY

Purpose: To determine the incidence of Elschnig pearl formation along the capsulotomy margin (string of pearls) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy and to elucidate its clinical features, p redisposing factors, effect on visual function, and association with a dditional capsulotomy. Setting: Keio University Hospital, Tokyo, Japan . Methods: The records of 418 eyes that had had Nd:YAG posterior capsu lotomy after cataract surgery were retrospectively reviewed. Of those, 315 were excluded for short follow-up (fewer than 12 months) or insuf ficient clinical examination data. In the remaining 103 eyes, the inci dence of string of pearls was calculated, and its clinical features, p redisposing factors, effect on visual function, and correlation with a dditional capsulotomy were evaluated. Results: String of pearls was id entified in 49 eyes (47.6%); 37 (75.5%) developed pearls within 1 year after Nd:YAG capsulotomy. The incidence was significantly higher in p atients having intraocular lens implantation and continuous curvilinea r capsulorhexis (CCC) than in those without (95.9 versus 61.1% and 97. 9 versus 55.6%, respectively). No significant differences were found i n patient age and sex, total Nd:YAG energy, and the presence of diabet es mellitus or high myopia. String of pearls caused visual disturbance s in 17 eyes (34.7%). The rate of repeal capsulotomy was higher in pat ients with string of pearls than in those without (36.7 and 9.3%, resp ectively). Conclusions: String of pearls formation was a common and si gnificant complication after Nd:YAG posterior capsulotomy. Intraocular lens implantation and CCC may promote its formation.