Abstract
To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.
Highlights
Pseudoexfoliation (PES) syndrome is distinguished by the deposition of fibrillar material into the anterior segment of the eye and other parts of the body[1]
We found a significant association between pseudoexfoliation syndrome and zonular dialysis, intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54)
Intraoperative complications consisted of posterior capsular rupture, vitreous loss, luxation of the nucleus, and lens luxation/subluxation
Summary
Pseudoexfoliation (PES) syndrome is distinguished by the deposition of fibrillar material into the anterior segment of the eye and other parts of the body[1]. PES is associated with distinct mutations, to those in the LOXL1 gene, which codes for lysyl oxidase-like 1(2), This content is licensed under a Creative Commons Attributions 4.0 International License. PES is extremely common in Scandinavia[4], with an incidence of approximately 22.4%, but it is rare in China, with a rate of approximately 0.4%(5). One premise is that production of pseudoexfoliative material by the lens epithelium might disrupt the zonular fibers attached to the lens, affecting its position in the lens capsule. Fibrillar material accumulation in the ciliary epithelium could disturb the attachment of zonular fibers, which, together with fiber destruction by lysosomal enzymes, could lead to capsular rupture[6]
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