Early Lensectomy in Patients With Pseudoexfoliation: Long-Term Effectiveness and Safety Outcomes

Abstract

Précis: Early lensectomy in patients presenting pseudoexfoliation (PXF) in an asymmetric clinical stage resulted in effective, safe, and predictable long-term results. Good intraocular pressure (IOP) was found, thus it might be considered as a possible surgical approach in these patients. Purpose:The purpose of this study is to assess the long-term effectiveness, predictability, and safety of cataract surgery performed in patients with capsular PXF at an early stage of the disease. Materials and Methods:This retrospective, comparative study included PXF patients who underwent phacoemulsification with hydrophobic acrylic intraocular lens implantation in both eyes with a postoperative follow-up ≥ 5 years. Patients were classified in 2 groups: symmetric PXF (n = 102) and asymmetric PXF (n = 59). Preoperative and postoperative uncorrected and corrected distance visual acuity, manifest refraction, IOP, number of hypotensive drugs, visual field mean deviation, and the incidence of complications were registered.Results: The mean follow-up time was 8.5 ± 2.8 years. Six months after cataract surgery, monocular uncorrected and corrected distance visual acuity were 0.3 ± 0.4 and 0.1 ± 0.3 logMAR, respectively, for the symmetric PXF, and 0.2 ± 0.2 and 0.1 ± 0.2 logMAR, respectively, for the asymmetric group. Total 95% and 96% of eyes were within ± 1.00D in symmetric and asymmetric groups, respectively. At the final follow-up, IOP decreased only in the asymmetric group (P = 0.004), with a reduction in the number of medications in both eyes (P < 0.001). Mean deviation changed from −8.8 to −11.6 dB in the symmetric group (P < 0.001), and from −5.0 ± 6.2 to −7.9 ± 10.6 dB (P = 0.42) in the asymmetric group. Intraoperative complications were only registered in the symmetric group: 7 (3.4%; P = 0.04). Ten cases (4.9%) of late intraocular lens dislocation were found, all from the symmetric group (P = 0.03).Conclusions: Early lensectomy in patients with PXF before its symmetric presentation resulted in effective, safe, and predictable long-term results.

Investigation of Risk Factors Predicting Cataract Surgery Complications in Patients with Pseudoexfoliation Syndrome: A Systematic Review

“…The study concluded that CML is not a predictive factor for cataract surgery results [ 29 ]. Our analysis therefore included six articles ( Table 2 ) [ 19 , 22 , 23 , 24 , 25 , 26 ]. There were two case-control studies [ 24 , 26 ] and four cohort studies [ 19 , 22 , 23 , 25 ].…”

“…Our analysis therefore included six articles ( Table 2 ) [ 19 , 22 , 23 , 24 , 25 , 26 ]. There were two case-control studies [ 24 , 26 ] and four cohort studies [ 19 , 22 , 23 , 25 ]. Two studies were conducted in Europe [ 22 , 26 ] and four were conducted in Asia [ 19 , 23 , 24 , 25 ].…”

“…We grouped “corneal edema”, “wound burn”, and “endothelial cell loss” as “endothelial cell decompensation” to avoid confusion. Three studies reported intraoperative complications [ 22 , 24 , 25 ], two studies reported postoperative complications [ 19 , 23 ], and one study reported both types of complications [ 26 ] ( Table 3 ).…”

“…The available data on outcomes are rather heterogeneous. Two studies considered the shallow anterior chamber (ACD) a risk factor [ 19 , 22 ], two studies proved that late-stage cataracts according to the Emery–Little lens opacity classification system may predict postoperative complications [ 19 , 23 ], one study focused on systemic inflammatory markers (NLR—neutrophil-to-lymphocyte ratio) to predict surgical events [ 24 ], one study proved that an intraocular pressure (IOP) above 23 mmHg can be a risk factor [ 25 ], and one study proved that PXF symmetry can influence surgical outcome [ 26 ]. ( Table 3 ).…”

“…Our review included two studies that considered shallow ACD as a risk factor [ 19 , 22 ], two studies that evaluated cataract grade according to the Emery–Little lens classification system as an outcome [ 19 , 23 ], one that analyzed the level of neutrophils and lymphocytes [ 24 ], one based on high IOP [ 25 ], and one examining the symmetry of pseudoexfoliative material for predicting clinical course [ 26 ].…”