Pseudoexfoliation syndrome: Clinical factors related to capsular rupture in cataract surgery

Abstract

Extracapsular surgery has a high frequency of capsular rupture or disinsertion in patients with pseudoexfoliation syndrome. Irido-phakodonesis is one of the factors that suggests this complication. Irido-phakodonesis acts as an 'all or nothing' mechanism, as it does not appear until there is a certain degree of zonular lesion. We carried out a study on 330 eyes with pseudoexfoliation, relating irido-phakodonesis to 31 clinical signs. The results showed that irido-phakodonesis is related to cataracts, degree of mydriasis, presence of glaucoma, atrophy of the pupilar pigmentary ruff, and uniform pigmentation of the trabecular meshwork. These results suggest that the signs which indicate the existence of zonular lesion during extracapsular surgery, include poor dilation, the presence of glaucoma and pigmentary alterations, whilst the pseudoexfoliation material deposited in the anterior segment does not appear to have a bearing on this complication.

Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study

“…1,2 PEX is linked to glaucoma and has a higher rate of intraoperative and postoperative complications during cataract surgery. [3][4][5] Both undilated and dilated slit-lamp biomicroscopy are used during the clinical examination to detect the white dandruff like material on the pupil, lens, and the angle, as well as other signs such as parapupillary transillumination defects. 6,7 PEX is not only an ocular disease, but also a generalized disorder that involves the abnormal production and/or turnover of extracellular matrix material.…”

Postmortem microscopic evaluation and clinical correlation of a pseudophakic eye with pseudoexfoliation and loss of zonular support

“…1 Cataract surgery in patients with pseudoexfoliation is associated with a statistically higher incidence of intraoperative and postoperative complications including vitreous loss, capsule rupture, zonule rupture, and pseudophakodonesis. [2][3][4][5][6][7][8] Delayed dislocation of the IOL has been reported, with subsequent need for surgical correlation. 9,10 This may be because eyes with pseudoexfoliation are noted to have weaker zonules and/or weaker lens capsules.…”

Pseudoexfoliation - A Dreaded Nightmare in Cataract Surgery

“…[9] The amount of exfoliative material in the zonules is not predictive of intra-operative zonule weakness. [10] The ages of patients diagnosed with PXE in this study were 60-80 years age group. Epidemiological studies of PXE have shown that it is more common in patients older than 60 years and prevalence further increases with age.…”