Cataract Surgery in Eyes with Pseudoexfoliation (PEX) Syndrome

Snježana Snježana

doi:10.4172/2155-9570-s1-009

Abstract

Pseudoexfoliation (PEX) syndrome is a common age-related systemic disorder characterized by a huge production and deposition of fibrillogranular amyloid-like extracellular material within many ocular tissues. Pseudoexfoliation is 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 two major risk factors for surgical complications and poor visual acuity after surgery. With proper preparation and use of specialized adjunctive devices, phacoemulsification (PHACO) is the preferred procedure of cataract extraction in this group of patients. Postoperatively pseudoexfoliation 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 risks of complications can be minimized and favourable outcomes can be achieved in cataract surgery in eyes with pseudoexfoliation syndrome.

Highlights

Pseudoexfoliation (PEX) syndrome is an age-related systemic disease with primarily ocular manifestations characterized by deposition of whitish-gray pseudoexfoliation fibrillogranular amyloid like material on the anterior lens capsule, zonules, ciliary body, pupillary margin of the iris, corneal endothelium, anterior vitreous and trabecular meshwork [1,2]
Exfoliation of fibrillogranular amyloid-like material has been found in many organs such as skin, heart, lungs, liver, kidney, gall bladder, blood vessels, extraocular muscle, connective tissue in the orbit, optic nerves and meninges suggesting that the pseudoexfoliation syndrome is an ocular disease and a general disorder that involves the abnormal production of extracellular matrix material [3,4]
There is a high prevalence of pseudoexfoliation syndrome in Scandinavian countries, Arabic populations and in Oman [6,7] whilst it is relatively rare among African Americans, Eskimos and Canadian Arctic populations

Summary

Introduction

Pseudoexfoliation (PEX) syndrome is an age-related systemic disease with primarily ocular manifestations characterized by deposition of whitish-gray pseudoexfoliation fibrillogranular amyloid like material on the anterior lens capsule, zonules, ciliary body, pupillary margin of the iris, corneal endothelium, anterior vitreous and trabecular meshwork [1,2]. Pigment loss from the iris sphincter region and its deposition on anterior chamber structures support the diagnosis. Detection of these signs requires a careful clinical examination using dilated slit-lamp biomicroscopy and undilated gonioscopy but frequently undiagnosed pseudoexfoliation can lead to unexpected problems in management and during surgery. Exfoliation of fibrillogranular amyloid-like material has been found in many organs such as skin, heart, lungs, liver, kidney, gall bladder, blood vessels, extraocular muscle, connective tissue in the orbit, optic nerves and meninges suggesting that the pseudoexfoliation syndrome is an ocular disease and a general disorder that involves the abnormal production of extracellular matrix material [3,4]. Recent genetic studies in multiple populations have identified the lysyl oxidase-like 1 (LOXL1) gene as a major contributor to the risk of developing pseudoexfoliation syndrome and pseudoexfoliation glaucoma. J Clinic Experiment Ophthalmol S1: 009. doi:10.4172/2155-9570.S1-009 in etiopathogenesis of pseudoexfoliation and it may be considered as a multifactorial disorder [12]

Implications for Cataract Surgery

Clinical complications

Pseudoexfoliation Syndrome and Phacoemulsification

Findings

Conclusion