Question:medium
A patient presented to eye OPD after 3 years of cataract surgery. Slit lamp finding was given. What is the likely diagnosis? 
A patient presented to eye OPD after 3 years of cataract surgery. Slit lamp finding was given. What is the likely diagnosis?
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Vision drop years after cataract surgery with a pearly/wrinkled membrane behind the IOL = posterior capsular opacification, treated by Nd:YAG capsulotomy.
Updated On: Jun 22, 2026
- PCO
- Bullous keratopathy
- Phakic glaucoma
- Lens subluxation
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The Correct Option is A
Solution and Explanation
Time-course reasoning. The single most useful clue here is "3 years after cataract surgery." Complications of cataract surgery can be grouped by timing, and the dominant late complication - appearing months to years later - is Posterior Capsular Opacification (the after-cataract).
Why it happens: during modern cataract surgery the posterior capsule is deliberately preserved to seat the intraocular lens. Lens epithelial cells left at the equator slowly proliferate and creep across this capsule, forming Elschnig pearls and fibrotic wrinkles. On the slit lamp these appear as a hazy, pearly, sometimes "fish-egg" membrane sitting behind the IOL, and the patient complains of blurred vision and glare returning years after an initially successful operation - precisely this presentation. Definitive treatment is a quick Nd:YAG laser posterior capsulotomy.
Discarding the alternatives: bullous keratopathy is an early-to-intermediate corneal endothelial failure showing corneal oedema, not a capsular finding; phakic glaucoma is not a recognised post-cataract diagnosis and concerns pressure, not capsular opacity; lens subluxation cannot occur to a natural lens that was already removed at surgery.
The late post-operative slit-lamp opacity behind the IOL is therefore PCO (Option A).
Why it happens: during modern cataract surgery the posterior capsule is deliberately preserved to seat the intraocular lens. Lens epithelial cells left at the equator slowly proliferate and creep across this capsule, forming Elschnig pearls and fibrotic wrinkles. On the slit lamp these appear as a hazy, pearly, sometimes "fish-egg" membrane sitting behind the IOL, and the patient complains of blurred vision and glare returning years after an initially successful operation - precisely this presentation. Definitive treatment is a quick Nd:YAG laser posterior capsulotomy.
Discarding the alternatives: bullous keratopathy is an early-to-intermediate corneal endothelial failure showing corneal oedema, not a capsular finding; phakic glaucoma is not a recognised post-cataract diagnosis and concerns pressure, not capsular opacity; lens subluxation cannot occur to a natural lens that was already removed at surgery.
The late post-operative slit-lamp opacity behind the IOL is therefore PCO (Option A).
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