PCO (Secondary Cataracts) but no Primary Cataracts?

[Eye-Kant-C]

I wonder how a person like me could actually get the posterior cloudiness (PCO), "secondary cataracts" without actually having cataracts in the first place? Isn't it caused by cells from the cataracts? Or is it actually a reaction to the IOL? I have read that Crystalens and other IOLs made of silicone have a very high incidence of PCO, something like 60%. Is this true?

[Eye-Kant-C]

Thank you so much for all your replies -- it's so confusing and I'm scared to death of detached retina as I know what my mom, sister, and husband went through with them. (My husband ended up blind in that eye, but mom & sis had good results.)

I feel that I lost so much and gained nothing with the Crystalens. I know they say the close vision may come in better in time, but at almost 3 months, mine is still much worse in the first eye than before the surgery.

I'll be trying the opaque contact lenses in a couple days to see if that cuts down on the flare/glare edge problems I'm dealing with.

[John C Hagan III, MD, FACS, FAAO]

When modern planned extracapsular cataract extraction by phacoemulsification (or in your case a clear lens exchange) is done the back wall (posterior capsule) is left in place to hold the implant and keep the vitreous out of the anterior chamber. Just beneath this membrane are cells that produce the lens fibers of the human eye.

When surgery is done a scraper or other instrument is used to try and remove all these cells. The reason is that if left they go on producing lens fibers which die (there is no longer a human lens) and cause the initially clear capsule to turn cloudy. The younger you are the higher the number of cells you have and the more likely you are to have posterior capsular opacification also called posterior capsular cataract.  In congenital and juvenile cataract this occurs 100% of the time so a hole is almost always cut in the membrane to see through when that happens.

So in a sense you did not have a cataract before but now you may have a posterior capsular cataract.

The overall incidence of PCO is now about 25-33%. When implants were started by extracapsular extraction in the late 70's and early 80's the percentage was 90%+.

I have not commited a figure to memory about the incidence of PCO with Premium implants. You should be easily able to search that figure over the internet.

JCH III MD