title: Elschnig pearl formation along the neodymium:YAG laser posterior capsulotomy margin. Long-term follow-up.
abstract: OBJECTIVE
  To examine the long-term occurrence and course of Elschnig pearl (string of pearls) formation along neodymium:YAG (Nd:YAG) laser posterior capsulotomy margins.
  
  
  METHODS
  Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
  
  
  METHODS
  The clinical records of eyes having an Nd:YAG posterior capsulotomy to treat posterior capsule opacification after cataract surgery were retrospectively reviewed. Kaplan-Meier and Cox proportional hazards analysis were performed.
  
  
  RESULTS
  Among 201 eyes, string of pearls developed in 139 (69.2%). The mean follow-up after the Nd:YAG posterior capsulotomy was 32.1 months +/- 25.3 (SD). At 2 years, the cumulative probability of developing string of pearls was 77.0% (95% confidence interval [CI], 70.6%-83.4%), after which it reached a plateau. Among the 139 eyes, 100 had sufficient data to be reviewed to assess the long-term outcome (mean follow-up from Nd:YAG posterior capsulotomy, 43.7 +/- 26.0 months). A second Nd:YAG posterior capsulotomy was performed in 18 eyes (18.0%) to treat progression of string of pearls, typically within 2 years after the initial Nd:YAG capsulotomy. The string of pearls disappeared spontaneously in 31 eyes (31.0%). The probability of disappearance was 80.4% (95% CI, 63.4%-97.4%) 8 years after the Nd:YAG posterior capsulotomy. Cox proportional hazards analysis identified no factor significantly favoring the disappearance of the string of pearls.
  
  
  CONCLUSIONS
  String of pearls was a common complication after Nd:YAG laser posterior capsulotomy. About 20% of cases were progressive and required a second capsulotomy; however, most regressed over several years.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. kurosaka@sc.itc.keio.ac.jp
authors.forename: Daijiro
authors.initials: D
authors.lastname: Kurosaka
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kato
authors.forename: Hiroyo
authors.initials: H
authors.lastname: Kurosaka
authors.forename: Mami
authors.initials: M
authors.lastname: Yoshino
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Nakamura
authors.forename: Kazuno
authors.initials: K
authors.lastname: Negishi
mesh_terms: D002386:Cataract / Q000209:etiology* / Q000503:physiopathology; D002387:Cataract Extraction / Q000009:adverse effects; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D007903:Lens Capsule, Crystalline / Q000473:pathology / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D011336:Probability; D016016:Proportional Hazards Models; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013997:Time Factors