Pseudoexfoliation syndrome for the comprehensive ophthalmologist Intraocular and systemic manifestationsHistorical image

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.…”

Effect of a capsular tension ring on prevention of intraocular lens decentration and tilt and on anterior capsule contraction after cataract surgery

“…1 We agree that lens zonules of eyes with pseudoexfoliation syndrome weaken progressively after cataract surgery. In a previous report, 2 we showed that the most important predisposing factor for in-the-bag intraocular lens (IOL) dislocation is pseudoexfoliation syndrome, possibly because of progressive weakening of the lens zonules. Furthermore, we also stated in our recent study 1 that the CTR does not prevent progressive zonular decline.…”

To know the Indicators and Predictors of Zonulopathy can Prevent the Headache of Eye Surgeon

“…Additionally, systemic diseases or syndromes that affect the zonules or fibrillin such as porphyria, hyperlysinemia, Marfan syndrome, homocystinuria, scleroderma, Weil-Marchesani syndrome and Ehlers-Danlos syndrome may cause the zonulopathy [4][5][6][7]. If the cause of zonulopathy is a specific disease such as pseudoexfoliation syndrome affecting the strength of the zonular system, the zonular fibers are more fragile and they are four times more likely to break [3,5,[7][8][9].…”

“…The common causes of zonulopathy are pseudoexfoliation syndrome, zonulolysis due to ocular trauma, iatrogenic zonulolysis due to previous ocular interventions damaging to the zonules such as lens surgery, pars plana vitrectomy, repeated intravitreal injections, and various ocular disorders including high myopia, spherophakia, retinopathy of prematurity, ultra-brunescent cataracts, retinitis pigmentosa, aniridia, advanced age and intraocular tumor. Additionally, systemic diseases or syndromes that affect the zonules or fibrillin such as porphyria, hyperlysinemia, Marfan syndrome, homocystinuria, scleroderma, Weil-Marchesani syndrome and Ehlers-Danlos syndrome may cause the zonulopathy [4][5][6][7]. If the cause of zonulopathy is a specific disease such as pseudoexfoliation syndrome affecting the strength of the zonular system, the zonular fibers are more fragile and they are four times more likely to break [3,5,[7][8][9].…”

“…Additionally, systemic diseases or syndromes that affect the zonules or fibrillin such as porphyria, hyperlysinemia, Marfan syndrome, homocystinuria, scleroderma, Weil-Marchesani syndrome and Ehlers-Danlos syndrome may cause the zonulopathy [4][5][6][7]. If the cause of zonulopathy is a specific disease such as pseudoexfoliation syndrome affecting the strength of the zonular system, the zonular fibers are more fragile and they are four times more likely to break [3,5,[7][8][9].Preoperative signs of zonulopathy are phacodonesis/pseudophacodonesis, iridodonesis, a tilted or subluxated or eccentric lens, the presence of a shallow or hyper deep anterior chamber in an eye, asymmetric axial anterior chamber or angle depth between both eyes, a space between iris and lens (iridolenticular gap) and visible lens equator [8,9].Intraoperative signs of zonulopathy include difficulty in the central perforation of the anterior lenticular capsule with the cystotome, extremely wrinkling and the mobility of the anterior lenticular capsule, and heavy movement of the peripheral lenticular capsule when capsular flap is maneuvered with capsule forceps (pseudoelasticity), the visualization of the peripheral capsule fornix, prominent anterior capsule stria (trampolining) during anterior capsulorhexis, eccentric nucleus displacement with difficult nucleus rotation, difficulty in the cortex removal with posterior capsular stria and infolding of the peripheral capsule during irrigation/aspiration of cortex, vitreal prolapse into the anterior chamber, sudden deepening of the anterior chamber during phacoemulsification [8,9]. Zonulopathy can cause the lens subluxation, vitreous prolapsus and consequently trigger the complications such as cystoid macular edema, retinal tears and other serious retinal or choroidal complications [3,5,6,10,11].…”