Long-Term Outcome of Cataract Surgery in Eyes with Pseudoexfoliation Syndrome Associated with Weak Zonules: A Case Report

Abstract

A cataract surgery in both eyes was scheduled for an 81-year-old female patient. However, ophthalmic examination revealed marked iridodonesis, phacodonesis and pseudoexfoliative material on the surface of the lens in both eyes indicating weak zonules caused by pseudoexfoliation syndrome, which was more pronounced in the left eye. Cataract surgery was performed initially in the left eye by phacoemulsification. Additionally, iris hooks and capsular tension ring (CTR) were used to stabilize the capsular bag, and the haptic of the intraocular lens (IOL) was sutured to the iris at the end of the surgery. The same procedure except haptic suturing was performed in the right eye after 6 months. The left eye remained stable, whereas the right eye developed considerable anterior capsular contraction 2 months postoperatively. Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy was performed to treat the condition. Moreover, 3 years after the initial surgery, late IOL-CTR-capsular-bag complex dislocation developed in the right eye, and reposition surgery was performed. Three days after IOL-CTR-capsular-bag complex reposition surgery, endophthalmitis developed; the eye responded well to 1 mg intravitreal vancomycin treatment. IOL in the right eye remained stable 3 years postoperatively.

Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support

“…This percentage is higher than observed in our patients; however, Monastam’s study had a longer follow-up period and did not report the actual timing of the late dislocations [ 6 ]. Our patients experienced the first cases of late IOL dislocation within the first three years of follow-up [ 11 ], much earlier than reported for Monastam’s study ( Table 3 ). We expect to find additional dislocations during our continuing follow-up.…”

“…Gunenc et al reported two cases of late IOL-CTR-capsular bag dislocations six years after the initial cataract surgery. The article also reported a simple technique for IOL-CTR-capsular bag repositioning by suturing it to the sulcus in twelve o’clock position at the edge of the CTR using 10/0 polypropylene suture [ 52 ]; we used the same approach [ 11 ].…”

“…The reported mean time of late IOL dislocation varies from 5 to 12.5 years after the initial cataract surgery [ 1 , 2 , 3 , 4 , 6 , 9 ]. Individual case reports from complicated surgeries have reported earlier occurrence, ranging from 2.5 to 8 years [ 10 , 11 ].…”

“…Numerous surgical approaches to treat the conditions have been developed, in case cataract surgery for these patients is necessary, which includes phacoemulsification with or without capsular tension ring implantation [ 22 , 25 , 26 , 27 , 28 ], different capsular bag and IOL fixation (sutured, glued) [ 11 , 29 ], and pars plana lentectomy combined with different types of IOL fixation [ 27 , 30 ]. In this prospective study we evaluated anterior capsule opening (ACO) contraction and late intraocular lens (IOL) dislocation and assessed the effectiveness of methods to reduce anterior capsule contraction after cataract surgery for patients with weak or absent zonules.…”

Acs lēcas priekšējās kapsulas atveres izmaiņas pēc kataraktas operācijas pacientiem ar subluksētu lēcu. Promocijas darbs

“…Vēlīnās IOL dislokācijas 5 gadu kumulatīvā incidence ir 0,30 % (Clark et al, 2011), 20 gadu kumulatīvā incidence ir ziņota 3 % (Monestam, 2019). IOL-CTRkapsulas maisa vēlīnā dislokācija vairāk ir ziņota kā gadījumu apraksti, parasti notiek 2,5 -8 gadus pēc nekomplicētas kataraktas operācijas ar CTR implantāciju pacientiem ar zonulu vājumu (Kocak et al, 2017;Vanags & Laganovska, 2020). Mönestam ziņo par 2 IOL-CTRkapsulas maisa vēlīno dislokāciju gadījumiem no 11 pacientiem 20 gadu periodā (Monestam, 2019).…”