Cataract Surgery in Pseudoexfoliation Syndrome

Abstract

Pseudoexfoliation (PEX) syndrome is an age-related systemic disorder with major ocular manifestations. It is characterized by the production and deposition of fibrillogranular amyloid-like extracellular material within many ocular tissues. Pseudoexfoliation is also a risk factor for glaucoma and also correlated to an increased incidence of cataract formation. Cataract surgery in eyes with pseudoexfoliation is connected with many complications and presents challenges that require careful preoperative planning and intraoperative care to ensure safe surgery and successful postoperative outcome. Zonular weakness and poor pupillary dilation are the two major risk factors for surgical complications and poor visual acuity after surgery. With proper preparation and the use of specialized adjunctive devices, phacoemulsification is the preferred procedure of cataract extraction in this group of patients. Postoperatively, patients require frequent and detailed follow-up to monitor for complications such as intraocular pressure rise, inflammation and intraocular lens dislocation. In conclusion, with appropriate preoperative, intraoperative and postoperative care, the risk of complications can be minimized and favorable outcomes may be achieved in cataract surgery in eyes with pseudoexfoliation syndrome. KEYWORDS: Pseudoexfoliation syndrome, Cataract surgery, Complications, CTR, Pupillary ring. INTRODUCTION:Pseudoexfoliation (PEX) syndrome is an age-related systemic disease which have primarily ocular manifestations characterized by the deposition of a whitish-gray pseudoexfoliation fibrillogranular amyloid-like material on the anterior lens capsule (Fig. 1), zonules, ciliary body, pupillary margin, corneal endothelium, anterior vitreous and trabecular meshwork. 1, 2 The most important diagnostic sign of PEX is whitish-grey flaky material on the pupillaryborder of the iris (Fig. 2) and the anterior surface of lens. The lens usually demonstrates three zones on the anterior lens capsule which consists of a relatively homogeneous central zone and a granular cloudy peripheral zone with a clear zone in between. For detecting these signs a careful clinical examination using dilated slit-lamp bio-microscopy and additionally un dilated gonioscopy are done. Undiagnosed PEX can lead to unexpected problems in management and during surgery.PEX is a risk factor for open-angle glaucoma, angle-closure glaucoma, lens subluxation, bloodaqueous barrier impairment, and serious intraoperative and postoperative complication and has been correlated with an increased incidence of cataract formation. Jonasson et al. reported a 10% annual increase for both open-angle glaucoma and PEX in persons of 50 years and over in Iceland. 3 Although the exact etiology of the condition as well as the exact structure of the material is still unknown. It is presumed that the production of pseudoexfoliation material is associated with abnormal metabolism of glycosaminoglycans and thus abnormalities of the basement membrane in the epithelial cells. Pse...

A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India

“…White-gray flaky debris on the anterior side of the lens or the pupillary border of the iris is the most widely recognized and easily identifiable diagnostic sign of pseudoexfoliation. 3 The diagnosis is supported by pigment deposition in the anterior chamber structures and pigment loss from the iris sphincter area. The examiner was primarily responsible for providing an accurate diagnosis of pseudo-exfoliation.…”