Zonular instability in patients with pseudoexfoliative syndrome: the analysis of 1000 consecutive phacoemulsifications

Abstract

Phacoemulsification (PHACO) is the gold standard of cataract surgery. Сataract surgery in eyes with pseudoexfoliative (PEX) syndrome is associated with increased risk of intra- and postoperative complications. Zonular laxity is one of the main causes of surgical complications. Purpose. To assess the degree of zonular weakness in patients with PEX. Materials and methods. 1010 eyes (580 eyes with PEX and 430 eyes without it) that underwent consecutive PHACO at the Ophthalmology Department No 5 of the City Multifunctional Hospital No 2 from May 2016 until October 2017 were enrolled in the study. The zonular laxity was assessed preoperatively and intraoperatively. Results. Zonular weakness was observed more often in patients with PEX, both at preoperative and intraoperative evaluation (p < 0.05). However, in both groups, the percentage of zonular weakness estimated intraoperatively, was several times higher, than that estimated preoperatively. Nevertheless there was no difference in the rate of capsular bag related intraoperative complications between two groups. (For citation: Potemkin VV, Ageeva EV. Zonular instability in patients with pseudoexfoliative syndrome: the analysis of 1000 consecutive phacoemulsifications. Ophthalmology Journal. 2018;11(1):41-46. doi: 10.17816/OV11141-46).

Pseudoexfoliative Syndrome in Cataract Surgery—A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia

“…Consequently, the use of a CTR was necessary in these eyes. Other studies have also reported a higher percentage of zonulopathy in the group of patients with PEX [ 19 ]. In four (1.44%) cases among our patients with PEX syndrome, the rupture of the posterior capsule and related complications prevented the primary implantation of an IOL.…”

“…All these factors contribute to an increased rate of intraoperative complications, including zonular dehiscence (separation or weakening of the lens zonular fibers), posterior lens capsule rupture, vitreous loss, and nucleus drop [ 2 , 6 , 13 , 18 , 19 , 20 ]. Additionally, a higher rate of postoperative complications has been reported, including corneal edema and descemetitis, elevated intraocular pressure (IOP) spikes, inflammation, anterior capsule phimosis, posterior capsule opacification, and intraocular lens (IOL) dislocation, often within the capsular bag [ 6 , 13 , 21 ].…”

Effect of capsular tension ring implantation during phacoemulsification on postoperative refraction

“…Some ocular and systemic conditions may result in zonular weakness: pseudoexfoliation syndrome (PEX), with or without glaucoma, Marfan's syndrome, retinitis pigmentosa and blunt trauma are the most common causes. 11 PEX and blunt trauma can lead to anterior chamber depth (ACD) fluctuations 12,13 which results in effective lens position (ELP) change. In cases of Marfan's syndrome, zonular fibers may be elongated and disintegrated leading to lens decentration.…”

Limbal mini-pockets for transscleral IOL fixation

“… 7 , 8 , 9 PEX is known to be a risk factor for various intra- and postoperative complications during PhE, including rupture of the zonules of Zinn and posterior capsule, vitreous body prolapse, anterior capsular contraction syndrome, IOL decentration and dislocation. 9 , 10 One of the main causes of intraoperative complications in PEX is zonular weakness. Frequency of its occurrence in PEX ranges from 8.4% to 10.6%.…”