Cataract Surgery in Pseudoexfoliation Syndrome

Abstract

Pseudoexfoliation (PXF) syndrome is characterized by the deposition of distinctive fibrillar material in the anterior segment of the eye. It is an age-related process that is associated with open and narrow angle glaucomas and the formation of cataracts. Not only is PXF associated with the formation of dense nuclear cataracts, it is also well known that those presenting with PXF are at a higher risk of developing complications during, and even after, cataract surgery. Complications associated with cataract surgery in PXF can occur from poor pupillary dilation, zonular weakness leading to intraoperative or postoperative lens dislocation and vitreous loss, postoperative intraocular pressure (IOP) spikes potentiating glaucomatous damage, capsular phimosis, prolonged inflammation, and postoperative corneal decompensation. The surgeon should be prepared to encounter the various potential intraoperative and postoperative complications in eyes with pseudoexfoliation syndrome during cataract surgery. In this way, the surgeon can plan his/her surgical technique to help avoid surprises during cataract surgery and be prepared to manage the potential postoperative complications that can occur in pseudoexfoliation eyes.

Proteomic Analysis of the Bovine and Human Ciliary Zonule

“…In exfoliation syndrome, for example, the zonular fibers are weakened, resulting in phacodonesis and subluxation of the lens, or even frank zonulysis. 19 , 20 Systemic metabolic disorders, such as homocystinuria, commonly result in lens dislocation (ectopia lentis) secondary to disintegration of zonular fibers. In isolation, ectopia lentis is associated with mutations in ADAMTSL-4, 21 , 22 but is also observed in syndromes resulting from mutations in genes such as FBN1 (Marfan syndrome; MIM:154700) and LTBP2 (Weill-Marchesani syndrome type 3; MIM:614819).…”

Long-Term Outcome of Cataract Surgery in Eyes with Pseudoexfoliation Syndrome Associated with Weak Zonules: A Case Report

“…Cataract surgery in case of weak zonules is more challenging and time consuming and has a higher risk of intraoperative and postoperative complications than ordinary cataract cases [2,3,8,11]. Phacoemulsification with capsular stabilizing devices is a more preferred surgical method than extracapsular or intracapsular cataract extraction and pars plana lensectomy combined with vitrectomy [4,5,11,12].…”

“…Pseudoexfoliation syndrome is associated with multiple ocular manifestations, including weak zonules [1]. If cataract surgery is necessary in such a case, it might be challenging for surgeons to perform the surgery [2,3]. To improve surgical outcome and long-term prognosis, different devices for weak zonule management have been introduced such as conventional and modified capsular tension rings (CTRs) and iris and capsular hooks [4][5][6].…”

The Outcomes of Cataract Surgery in Small and Normal Pupillary Eyes with Pseudoexfoliation

“…Cataract surgery is a necessary method to increase vision in patients with low vision due to cataract (20,21). In pseudoexfoliation cases, cataract causes a decrease in vision and surgical intervention is necessary to increase vision (22,23). Many studies have shown that pupillary dilatation in eyes with pseudoexfoliation is insufficient (24,25).…”