Fibrillopathy in a pseudophakic eye

The purpose of the study was to evaluate the distribution and amount of pseudoexfoliation material (PXM) on anterior segment structures in pseudophakic human autopsy eyes with pseudoexfoliation (PEX) syndrome and to study its impact on fixation and decentration of posterior chamber intraocular lenses (IOLs). Sixteen human autopsy eyes (donor age [mean ± SD] 77.5 ± 8.6 years; range, 70-90 years) with history of cataract surgery and PEX syndrome were analyzed for distribution and accumulation of PXM on structures of the anterior segment by light microscopy. Quantitative IOL decentration measurements were performed using the Miyake-Apple posterior view technique. All 16 eyes displayed IOLs which were either fixed symmetrically in the capsular bag (n = 8) or asymmetrically with one haptic in the sulcus and one in the bag (n = 7) or at the pars plicata of the ciliary body (n = 1). In the majority, PXM was found around the pars plicata (average grade: 1.6 ± 0.53 µm) and the lens capsule (average grade: 1.05 ± 0.46 µm). Minor amounts were detected at the pars plana and the trabecular meshwork. IOL decentration measurements ranged from 0.51 ± 0.35 (symmetrical-fixation) to 0.61 ± 0.43 mm (asymmetrical-fixation). There was only a weak statistically not significant correlation in regard to the amount of PXM and IOL decentration and between PXM distribution and the IOL fixation site. PXM contributes to weakening of the suspensory apparatus of the crystalline lens. Although PXM induced tissue alterations predispose for a broad spectrum of intra- and postoperative complications, the amount and distribution of PXM on different anterior segment structures showed only a weak correlation to IOL decentration or fixation location.

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Pseudoexfoliation and the cataract surgeon: Preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses

Shingleton¹,

Crandall²,

Ahmed³

2009

Journal of Cataract and Refractive Surgery

150

131

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This review provides a comprehensive assessment of intraocular pressure (IOP), phacoemulsification techniques, and intraocular lenses (IOLs) in pseudoexfoliation (PXF) eyes having cataract surgery. Pseudoexfoliation is ubiquitous and the most common cause for open-angle glaucoma worldwide. Cataracts occur with increased frequency in PXF eyes, and surgery is potentially complicated by the presence of small pupils and zonule laxity and significantly affects IOP in these eyes. Preoperative evaluation and the options for intraoperative management of cataract are presented with recommendations for the use of adjunctive pupil and zonule support devices. Postoperative complications such as capsule contraction and IOL instability are discussed and laser and surgical options to manage these special problems presented.

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Fibrillopathy in a pseudophakic eye

Cited by 8 publications

References 16 publications

Pseudoexfoliations-Syndrom: Morphologie und Komplikationen

Pseudoexfoliations-Syndrom: Morphologie und Komplikationen

Distribution of pseudoexfoliation material on anterior segment structures in human autopsy eyes after cataract surgery with intraocular lens implantation

Pseudoexfoliation and the cataract surgeon: Preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses

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