Phacoemulsification in Pseudoexfoliation Syndrome

Abstract

Purpose: To compare the incidence of intraoperative and early postoperative complications (IEPC), visual outcomes, and change in intraocular pressure (IOP) between eyes with and without pseudoexfoliation syndrome (PEX) having cataract extraction by phacoemulsification. Material and Method: 800 eyes with PEX and 1,600 eyes without PEX having cataract extraction by phacoemulsification were included in this retrospective study. Evaluated parameters were incidence of IEPC, visual outcomes and change in IOP. χ² and Student’s t test were used for statistical analysis. Results: There were no significant differences in the incidence of IEPC and visual acuity gain between the two groups (p > 0.05). Rise in IOP in the early postoperative period was significantly higher in the PEX group (p < 0.02). Conclusion: Patients with PEX who have phacoemulsification can achieve results similar to patients without PEX. IOP control in the early postoperative period seems to be more important in patients with PEX.

Diurnal Curve after Phacoemulsification in Patients with Pseudoexfoliation Syndrome and Cataract

“…1,3,4 Cataract surgery was proven to have a beneficial effect on IOP control in glaucoma in earlier reports. [5][6][7][8][9][10][11][12]14,15 A higher reduction of IOP in eyes with higher preoperative IOP was observed by Shingleton et al in their study where they observed 2.7% eyes progressing to XFG after a period of 3 years despite a 2-4 mm Hg reduction of IOP in XFS eyes. 5,6 However, several of the earlier studies compared the outcomes of cataract surgery between pseudoexfoliation syndrome, POAG, and age matched normals.…”

“…5,6 However, several of the earlier studies compared the outcomes of cataract surgery between pseudoexfoliation syndrome, POAG, and age matched normals. [6][7][8][9][10][11][12][13][14][15][16][17] We chose to study the effects of cataract surgery on the diurnal curve in these patients and compare the outcomes in eyes with an open and narrow angle since that may give us an insight as to the possible etiopathologic role of a cataractous lens on the outflow facility and pressure-related pathogenic mechanisms of glaucomatous damage.…”

“…[1][2][3][4] Cataract extraction in these patients is wrought with a high rate of complication owing to weak zonules, poor dilatation, and frequent subluxation of the lens and postoperative intraocular pressure (IOP) spikes. [5][6][7][8][9][10][11][12][13][14][15] The involved eye in unilateral pseudoexfoliation has a higher IOP and higher diurnal variation as compared to the clinically normal eye. 3,16 Whether the exact pathogenesis of exfoliation glaucoma is predominantly pressure related or ischemic remains unproven beyond doubt; beneficial effects of cataract surgery on better IOP control in XFS have been reported in a few studies.…”

Pseudoexfoliation and Cataract

“…Phacoemulsification in PXF eyes is associated with increasd rates of capsular and zonular tears and vitreous loss (Drolsum et al, 1993;Shingleton et al, 2003). On the other hand, recent studies around the world have shown no statistically significant difference in complication rates during phacoemulsification of PXF eyes (Akinci et al, 2008;Dosso et al, 1997;Hyams et al, 2005) than earlier studies that showed up to a 10-fold increase. Phacoemulsification performed by experienced surgeons, in combination with advanced technologies and devices, have decreased the risks.…”

Pseudoexfoliation: High risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification

“…One study 21 found that although the complications were more frequent in eyes with PXF than in eyes without, the long-term outcomes between the 2 groups were similar. Another study 24 found equal intraoperative complications (in the absence of preoperative phacodonesis or subluxation) except for an increased rate of early postoperative intraocular pressure (IOP) spikes in eyes with PXF. These and other studies focus on features associated with PXF that might place the eye at a higher risk for complications during the course of cataract surgery.…”