To observe and document the effect of steroidal and nonsteroidal antiinflammatory treatment on the formation of Elschnig pearls.

A prospective, randomized, double blinded, placebo controlled, two-way-cross-over study.

Thirty-nine eyes of 32 patients with pronounced, regeneratory posterior capsule opacification (PCO) were included. The patients were treated topically with prednisolone and diclofenac (verum) or with lubricating eye drops (placebo) four times daily for one week. After a wash-out period of two weeks the patients received the contrary treatment also four times daily for one week. Digital retroillumination images were taken at day one, three, five, eight, and 15 of each medication period. The changes in the size of 4675 Elschnig pearls were analyzed.

The mean cumulative area of all marked pearls/eye and follow-up was 1.2 mm² (range: 0.1 mm² to 3.2 mm²). The mean pearl size was 12809 μm² (range: 60 μm² to 1.08 × 10⁶ μm²). Between the follow-up examinations, 1274 pearls disappeared (mean: 33 pearls/eye, range: five to 69 pearls; 27%) and 777 newly formed pearls appeared (mean: 20 pearls/eye, range: three to 53 pearls; 20%). There was no statistically significant difference in pearl size change and in number of disappeared and newly appeared pearls between the verum and the placebo treatments.

Topical prednisolone and diclofenac do not influence the short-term change of Elschnig pearls. Elschnig pearls disappear and appear within days. The degree of progression and regression varies greatly among eyes.