Outcomes of cataract surgery in pseudoexfoliation syndrome in England: 10-year retrospective cohort study

Abstract

Purpose: To investigate the outcomes of cataract surgery in eyes with pseudoexfoliation syndrome in a real-world National Health Service setting. Setting: Prince Charles Eye Unit, Windsor, United Kingdom. Design: Single-center retrospective cohort study. Methods: All eyes that underwent phacoemulsification cataract surgery from January 2010 to December 2019 were included. Eyes with combined intraocular surgery or with a history of ocular trauma were excluded. Eyes were classified as pseudoexfoliation (n = 280 [1.2%]) or no pseudoexfoliation (n = 23 049). The primary outcome was mean change in logarithm of the minimum angle of resolution (logMAR) visual acuity (VA). Secondary outcomes included intraoperative and postoperative complications. Results: The study comprised 23 329 eyes of 15 257 patients. Eyes in the pseudoexfoliation group were older and more likely to have multiple co-pathologies. Intraoperatively, they were more likely to experience zonular dialysis and dropped nucleus. Postoperatively, they had significantly higher rates of corneal edema, elevated intraocular pressure, postoperative uveitis, and intraocular lens subluxation and were more likely to require a second operation within 90 days. Although the pseudoexfoliation group had worse preoperative and postoperative logMAR VA, logistic regression analysis confirmed that mean VA improvement was comparable to reference group (mean ± standard deviation −0.49 ± 0.52 vs −0.55 ± 0.66, adjusted mean difference 0.02 [95% CI, −0.01 to 0.06]). Conclusions: Although patients with pseudoexfoliation had a significantly higher risk of some complications, they achieved similar VA improvements with cataract surgery compared to the nonpseudoexfoliation group. These findings will help inform the consent process and management of patient expectations.

Long-Term Outcomes of a Kahook Dual Blade Procedure Combined with Phacoemulsification in Japanese Patients with Open-Angle Glaucoma

“…IOP spikes occurred more often in eyes with ExG than in those with POAG (23.7% vs. 9.1%). Patients with ExG tend to have higher rates of elevated IOP than those without ExG after cataract surgery [ 29 ]. This tendency might have contributed to the significant difference in IOP spikes between the two groups.…”

Complications and visual outcome of cataract surgery in pseudoexfoliation patients

“…Results similar to our study with high incidence of zonular dialysis and dropped nucleus were also seen in 10 year retrospective cohort study done in England. 18 A study by Avramides et al had shown zonulolysis in 13.09%; posterior capsule tear in 10.71% and vitreous loss in 7.14%. 10 Another study by Joshi et al had shown intraoperative difficulties in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), but zonular dehiscence (18 eyes, 8%) being the most common complication.…”

Axisymmetric Finite Element Modelling of the Human Lens Complex under Cataract Surgery

“…Bag dislocation in these situations usually occurs a long time after cataract surgery, with a mean interval of 6.9-8.5 years [9][10][11]. In silico studies shall help understand the mechanics of the IOL dislocation, and study the parameters that could influence this complication, due to its increasing incidence following the increase of procedures performed to remove cataracts [12][13][14]. However, only a few computational studies on the crystalline lens are found in literature and to the authors' knowledge there are none addressing the IOL dislocation.…”

“…This results in the reduction of the transmission of light and in scattering light, leading to blurred vision, and in the extreme to blindness, when not treated in time. Recently, the most common solution available is the complete removal of the cataract, i.e., of the crystalline lens, followed by an implant of an IOL in the capsular bag to replace it, leaving the eye in a pseudophakic state [12,22,23].…”