Islands of lens epithelial cells on the posterior capsule in pseudophakic eyes

PURPOSE: To evaluate the natural history of focal collections (islands) of lens epithelial cells (LECs) on the posterior capsule after cataract surgery. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: Patients in previous studies with various intraocular lenses (IOLs) and at least a 2-year follow-up were identified. Postoperative digital retroillumination images of each eye taken at 1, 3, and 6 months and 1 and 2 years were assessed for the presence of LEG islands and their incidence, etiology, time of appearance, change with time, and relationship to IOL material. RESULTS: Islands of LECs were identified in 39 eyes with an AcrySof SA60AT IOL, 40 eyes with a Rayner Centerflex C570H IOL, and 27 eyes with a Hoya YA6OBB IOL. In all groups, the islands tended to appear within 6 months with a decreasing incidence thereafter. Floating LECs that seeded on the posterior capsule (seeded LECs) or LECs left on the posterior capsule at surgery were seen in a small number of eyes. Most islands were derived from regression of a previous LEC membrane, and a majority continued to regress. Intraocular lens material had no influence on the natural history or morphology of the islands. CONCLUSION: Islands of LECs were common postoperatively. Equatorial LECs appeared to be the major cause of clinical posterior capsule opacification (PCO). Floating LECs in the aqueous that seeded on the posterior capsule or LECs left behind after surgery did not appear to contribute to clinical PCO.