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Background: This study explores the relative influence of fibrosis and pearl-type posterior capsule opacification (PCO) on visual function. It also examines the relevance of analyzing different central areas of posterior capsule on visual function., Methods: Thirty-eight eyes of 33 patients had their vision tested and posterior capsules photographed digitally. Each patient then underwent Nd:YAG laser capsulotomy. Patients returned 1 week later for repeat vision tests and photography. Analyses of areas of pearls and fibrosis were performed using the EPCO software system. The difference in these values before and after Nd:YAG laser capsulotomy was compared to change in vision for each patient. The effect of analyzing the central 1.5-, 2.5- and 3.5-mm zones was studied., Results: Stepwise multiple linear regression analysis shows that improvements in distance and near acuity are most strongly related to the central 1.5-2.5 mm of fibrosis and the central 3.5 mm of pearls. Improvements in contrast sensitivity are most strongly related to the central 1.5 mm of both fibrosis and pearls., Conclusion: In the assessment of PCO, the location and morphology of opacification correlate with visual function. Central fibrosis and paraxial pearls are important determinants of visual dysfunction.

Background: There are no prospective controlled trials comparing methods of capsulotomy or patterns of capsulotomy openings in similarly graded opacified posterior capsules. This paper aims to investigate the effect of various forms of posterior capsular opacification (PCO) capsulotomy openings on visual function, Methods: Thirty-six eyes of 34 patients had vision tested and posterior capsules were digitally photographed. Each patient then underwent Nd:YAG laser capsulotomy. Patients returned 1 week later for repeat vision tests and photography. Analyses of areas of pearls and fibrosis were performed using the EPCO software system. Analyses of size and shape of capsulotomy was also done with image analysis software. The capsulotomy characteristics were analysed with respect to improvements in vision, taking into consideration the PCO scores., Results: No correlation was found between capsulotomy dimensions and visual function improvement, even when PCO details were included in the analyses. Neither capsulotomy area, eccentricity, nor shape irregularity in the ranges measured was found to correlate significantly with eventual visual outcome in terms of contrast sensitivity, near and distance visual acuity, or glare readings., Conclusion: Performing a small capsulotomy (at least 1.5 mm in diameter), even if decentred up to 1 mm, may allow for satisfactory visual performance as long as the aperture is clear and not obscured by residual strands.