Written by Tabish Mehraj, PhD. Findings of this double-blinded, placebo-controlled, single-center randomized trial show that subjects supplementing with 200 mg of oral ginkgo biloba extract (GbE) daily for 6-months post-surgery resulted in 80.6% of eyes remaining free of pearls (P < 0.001) and 68.4% of the GbE group showing no fibrosis (P<0.001) at the 36-month follow-up compared to placebo.

Posterior capsular opacification (PCO) is considered to be the most common complication post-cataract surgery, which affects up to 28% of patients. It results from the increase and epithelial-mesenchymal transition (EMT) of residual lens epithelial cells, mainly driven by the action of transforming growth factor-beta (TGF-β). Nd: YAG (neodymium-doped yttrium aluminum garnet; Nd:Y₃Al₅O₁₂) laser capsulotomy is the standard treatment; however, it carries risks, including retinal detachment. Ginkgo biloba extract (GbE) is a popular herbal supplement with anti-fibrotic and antioxidant properties, achieved by inhibiting TGF-β signaling. This study assesses the systemic GbE supplementation as a non-invasive prophylaxis to prevent PCO (Posterior Capsule Opacification) and maintain long-term visual clarity.

This clinical trial evaluated the efficacy of oral GbE in preventing PCO. The study analyzed its effects on visual acuity, the extent of pearl and fibrotic PCO, and the need for Nd:YAG laser capsulotomy. This double-blinded, placebo-controlled, single-center randomized trial was conducted at Bu Ali Sina Hospital, Iran. A total of 156 patients (144 analyzed), aged 50–85 with senile cataracts, were randomized to receive either 200 mg of oral GbE (LI 1370) daily or a placebo for 6 months post-surgery. Follow-ups were conducted at 1 week, 1 month, 6 months, 12 months, and 36 months. Parameters included LogMAR visual acuity, PCO severity scores (pearl: 0–4; fibrosis: 0–3). Data were analyzed using independent t-tests, Chi-square tests, and Mann-Whitney U tests.

Results/Key Findings

• In terms of visual clarity, the placebo group showed a decline starting at 12 months (P = 0.003). By 36 months, mean LogMAR BCVA was 0.099 in the GbE group versus 0.194 in the placebo group (P = 0.005).
• At 36 months, 80.6% of GbE eyes remained free of pearls, compared to 54.5% in the placebo group (P < 0.001).
• At three years, 68.4% of the GbE group showed no fibrosis, whereas only 30.7% of the placebo group remained fibrosis-free (P < 0.001).
• Laser intervention was required in only 6.1% (6 eyes) of the GbE group compared to 20.4% (18 eyes) of the placebo group (P = 0.004).
• 3% of GbE-treated lenses remained entirely clear at three years, significantly higher than the 29.5% in the placebo group (P < 0.001).

The 200 mg daily GbE for six months post-surgery successfully reduces  PCO. This intervention preserves visual acuity and significantly reduces the need for Nd: YAG laser capsulotomy. GbE offers a safe, low-cost adjunctive therapy to improve long-term outcomes for cataract patients by targeting the underlying fibrotic mechanisms of PCO. There are several strengths to this study, as this is the first clinical trial to demonstrate the efficacy of systemic GbE in preventing human PCO, providing high-level evidence for a novel prophylactic approach. The use of a double-blinded, randomized, placebo-controlled design minimizes bias and strengthens the validity of the findings. The 36-month observation period is sufficient to capture the progression of late-onset PCO and the true necessity for laser intervention. Confounding variables were minimized through a single-surgeon approach and a consistent IOL model across all participants. PCO was assessed via manual slit-lamp grading, which is more subjective than automated digital quantification systems. A few limitations to this study are that the results from a single institution may not be fully generalizable to more diverse global populations or different surgical settings. While the cohort was ethnically uniform, the lack of strict control over individual dietary habits could potentially influence systemic antioxidant levels. The use of per-eye analysis rather than per-patient analysis may slightly impact statistical interpretations, though findings remained consistent across sensitivity checks.

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Posted August 14, 2026.

Dr. Tabish Mehraj is a pharmaceutical scientist with expertise in pharmaceutics, drug delivery, and formulation development. She earned her PhD in Pharmaceutical Sciences from the University of Mississippi, where her research focused on the formulation, optimization, and characterization of lipid-based nanocarriers for targeted liver delivery of antimalarial therapeutics. Dr. Mehraj has also served as an ORISE Fellow at the U.S. Food and Drug Administration (FDA), where she evaluated the effects of formulation and process design on the quality and performance of intravaginal drug delivery systems and developed bio-relevant in vitro drug release testing methods. She has teaching experience in pharmaceutical and life sciences courses and has authored peer-reviewed publications, book chapters, and conference presentations. Dr. Mehraj is an active member of the American Association of Pharmaceutical Scientists and has been recognized by honor societies including Rho Chi and Gamma Beta Phi.

Reference:

1. Amiri, A. A., Jafari, R., Amiri, A. A., Rad, H. A., Daneshvar, F., Charati, J. Y., & Amiri, A. A. (2025). Effect of Ginkgo biloba extracts in the prevention of posterior capsule opacification after cataract surgery: A randomized clinical trial. Oman Journal of Ophthalmology, 18(2), 126.