Cataract Surgery In Pseudoexfoliation Syndrome Research Articles

Evaluation of changes of anterior segment parameters in patients with pseudoexfoliation syndrome after cataract surgery using anterior segment optical coherence tomography

The aim of the study was to compare the anterior segment parameters after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes. We conducted a prospective comparative study of 36 eyes (PEX group), 16 eyes (PEXG group) and 46 eyes (control group) of 98 patients after phacoemulsification with intraocular lens implantation. Before surgery, 1 week, 1 month and 3 months postoperatively, anterior chamber parameters were evaluated by swept source anterior segment optical coherence tomography (AS-OCT). Anterior chamber depth (ACD), angle opening distance (AOD500/750), trabecular-iris space area (TISA500/750), trabecular-iris angle (TIA500/750) and lens vault (LV) were assessed at each study visit. Preoperatively, ACD, AOD500/750 and TISA500/750 were significantly smaller, while LV was significantly greater in PEX and PEXG eyes than in controls. 3 months postoperatively all irido-corneal parameters and ACD were significantly greater in all study groups without intergroup differences. ACD and LV significantly increased in PEX group between 1 and 3 months after surgery while being stable in control group. Relative increases in ACD, AOD500, TISA750, TIA500/750 were significantly higher in PEX and PEXG groups than in controls. Our study finds that ACD and iridocorneal parameters in AS-OCT demonstrated significantly greater relative increases 3 months after phacoemulsification in PEX and PEXG groups than in control eyes. Significantly greater deepening of anterior chamber and opening of the irido-corneal angle may be a reason for different refractive outcomes and IOP control in patients with PEX and PEXG after routine cataract surgery.

Refractive Outcomes of Uneventful Cataract Surgery in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma.

PurposeTo compare the refractive outcomes after cataract surgery between patients with and without pseudoexfoliation, and to evaluate the risk factors of refractive error.MethodsRetrospective review of 210 eyes with pseudoexfoliation (study group) and 510 normal eyes (control group) that underwent uneventful phacoemulsification with intraocular lens implantation. The study group included pseudoexfoliation syndrome and pseudoexfoliation glaucoma (PXG) subgroups. The main outcome measure was refractive error, defined as the difference between the target refraction and postoperative refraction in diopter (D). A refractive error >±1.0 D was identified as a large-magnitude refractive error. The frequency of the large-magnitude refractive error was compared between study and control groups, and also between each subgroup and normal eyes. The factors influencing refractive error were analyzed by logistic regression.ResultsThere was a significantly higher frequency of a refractive error >± 1.0 D and hyperopic error >1.0 D in the study group than in the control group (p = 0.001 and p = 0.003, respectively). In the multivariate logistic regression analysis, PXG and poor preoperative visual acuity were related with a large-magnitude refractive error (p = 0.001 and p = 0.02, respectively) Refractive error >± 1.0 D and hyperopic error >1.0 D were noted more often in PXG eyes that had an intraocular pressure spike >25 mmHg at postoperative first 24 hours (p = 0.01 and p=0.03, respectively).ConclusionsThe eyes with pseudoexfoliation were at a high risk for refractive error, especially in the presence of glaucoma. In PXG, the only significant risk factor for refractive error was observed to be the presence of an intraocular pressure spike.

Cataract surgery in pseudoexfoliation syndrome

Cataract surgery in pseudoexfoliation syndrome

Intraocular lens power calculations in eyes with pseudoexfoliation syndrome

To compare refractive outcomes after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes and to investigate the accuracy of 3 intraocular lens (IOL) calculation formulas in these eyes. In this prospective comparative study 42 eyes (PEX group) and 38 eyes (control group) of 80 patients were included. The follow-up was 3 months. The refractive prediction error (RPE), mean absolute error (MAE), median absolute error (MedAE) and the percentages of eyes within ± 0.25 D, ± 0.5 D, ± 1.0 D and ± 2.0 D of prediction error were calculated. Three IOL calculation formulas (SRK/T, Barrett Universal II and Hill-RBF) were evaluated. PEX produced statistically significantly higher mean absolute errors and lower percentages of eyes within ± 0.5 D than control eyes in all investigated IOL calculation formulas. There were no statistically significant differences in the median absolute errors between the 3 formulas in either PEX or control eyes. Refractive outcomes after cataract surgery are statistically significantly worse in PEX than in control eyes. All three IOL calculation formulas produced similar results in both PEX and control eyes.Trial registration: ClinicalTrials.gov registration number NCT04783909.

Outcomes of cataract surgery in pseudoexfoliation syndrome in England: 10-year retrospective cohort study.

To investigate the outcomes of cataract surgery in eyes with pseudoexfoliation syndrome in a real-world National Health Service setting. Prince Charles Eye Unit, Windsor, United Kingdom. Single-center retrospective cohort study. All eyes that underwent phacoemulsification cataract surgery from January 2010 to December 2019 were included. Eyes with combined intraocular surgery or with a history of ocular trauma were excluded. Eyes were classified as pseudoexfoliation (n = 280 [1.2%]) or no pseudoexfoliation (n = 23 049). The primary outcome was mean change in logarithm of the minimum angle of resolution (logMAR) visual acuity (VA). Secondary outcomes included intraoperative and postoperative complications. The study comprised 23 329 eyes of 15 257 patients. Eyes in the pseudoexfoliation group were older and more likely to have multiple co-pathologies. Intraoperatively, they were more likely to experience zonular dialysis and dropped nucleus. Postoperatively, they had significantly higher rates of corneal edema, elevated intraocular pressure, postoperative uveitis, and intraocular lens subluxation and were more likely to require a second operation within 90 days. Although the pseudoexfoliation group had worse preoperative and postoperative logMAR VA, logistic regression analysis confirmed that mean VA improvement was comparable to reference group (mean ± standard deviation -0.49 ± 0.52 vs -0.55 ± 0.66, adjusted mean difference 0.02 [95% CI, -0.01 to 0.06]). Although patients with pseudoexfoliation had a significantly higher risk of some complications, they achieved similar VA improvements with cataract surgery compared to the nonpseudoexfoliation group. These findings will help inform the consent process and management of patient expectations.

Cataract surgery in pseudoexfoliation syndrome

Phacoemulsification is a main method of cataract surgery. The presence of pseudoexfoliation syndrome (PEX) may involve the procedure in difficulty and contribute to development of intra- and postoperative complications. Purpose. To assess the effect of PEX on phacoemulsification. Materials and methods. 1010 patients (580 with PEX and 430 without PEX) admitted for cataract surgery, underwent phacoemulsification with implantation of various IOL types. An analysis of main phacoemulsification parameters was carried out: cumulative dissipated energy (CDE), aspirated BSS amount, time of surgery. The prevalence of some possible intraoperative complications was assessed: descemet membrane detachment, posterior capsule rupture, retrolental lens material, and zonular dialysis. Results. In patients with PEХ, local descemet membrane detachment and retrolental lens material were significantly more common, at the same time CDE was higher. Conclusion. When planning phacoemulsification, patients with PEX require more thorough preoperative examination, higher alertness during surgery and longer follow-up in the postoperative period.

Cataract surgery in pseudoexfoliation syndrome

Phacoemulsification is a main method of cataract surgery. The presence of pseudoexfoliation syndrome (PEX) may involve the procedure in difficulty and contribute to development of intra- and postoperative complications.
 Purpose. To assess the effect of PEX on phacoemulsification.
 Materials and methods. 1010 patients (580 with PEX and 430 without PEX) admitted for cataract surgery, underwent phacoemulsification with implantation of various IOL types. An analysis of main phacoemulsification parameters was carried out: cumulative dissipated energy (CDE), aspirated BSS amount, time of surgery. The prevalence of some possible intraoperative complications was assessed: descemet membrane detachment, posterior capsule rupture, retrolental lens material, and zonular dialysis.
 Results. In patients with PEХ, local descemet membrane detachment and retrolental lens material were significantly more common, at the same time CDE was higher.
 Conclusion. When planning phacoemulsification, patients with PEX require more thorough preoperative examination, higher alertness during surgery and longer follow-up in the postoperative period.

Anti-inflammatory Medication of Cataract Surgery in Pseudoexfoliation Syndrome – NSAID Is Needed

ABSTRACT Background To optimize the anti-inflammatory treatment of cataract surgery in pseudoexfoliation syndrome (PXF) eyes. Methods A prospective randomized double-masked trial. Sixty eyes of 60 patients with PXF undergoing routine cataract surgery were randomized for potent topical postoperative anti-inflammatory medication either with prednisolone acetate (10mg/ml), nepafenac (1mg/ml) or their combination. Clinical outcome parameters were recorded at 28 days and 3 months. Recovery from surgery was recorded by a structured home questionnaire. Results Patient age and gender distribution, and all baseline ophthalmic and surgical parameters were comparable between the study groups. At 28 days, change in central subfield macular thickness was +11.4 ± 11.9 µm in prednisolone acetate group compared to +1.7 ± 16.8 µm in nepafenac (P = .017), and −0.3 ± 8.7 µm in combination therapy (P = .010) groups. At 3 months, the values were +11.8 ± 18.1 µm, +1.8 ± 17.5 µm (P = .055), and −1.3 ± 6.4 µm (P = .055), respectively. Pseudophakic cystoid macular edema (PCME) was reported in two eyes, both with prednisolone acetate monotherapy. After surgery, conjunctival injection lasted 6.5 ± 5.0 days and irritation of the eye 9.5 ± 8.5 days in prednisolone acetate group compared with nepafenac (2.6 ± 2.2 days; P = .037 and 4.3 ± 5.2 days; P = NS, respectively) and combination therapy (3.3 ± 1.9 days; P = NS and 3.0 ± 4.0 days; P = .025, respectively). Conclusions Routine cataract surgery of PXF eyes with nonsteroidal anti-inflammatory drugs (NSAID) alone, or in combination with steroids resulted in faster recovery from surgery and avoidance of PCME compared to steroids alone. Abbreviations BAB: blood–aqueous barrier; CDVA: corrected distance visual acuity; CDE: cumulative dissipated energy; CSMT: central subfield macular thickness; HRQoL: Health-related quality of life; IOP: intraocular pressure; logMAR: log of the minimum angle of resolution; NSAID: nonsteroidal anti-inflammatory drug; PCME: pseudophakic cystoid macular edema; PXF: pseudoexfoliation syndrome; OCT: optical coherence tomography; t.i.d.: three times a day; VA: visual acuity

One year study of complications of cataract surgery in pseudoexfoliation syndrome in rural area (Eye camps)

One year study of complications of cataract surgery in pseudoexfoliation syndrome in rural area (Eye camps) - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.112, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Anatomical and Topographical Relations between the Posterior Lens Capsule and the Intraocular Lens in Pseudoexfoliation Syndrome

Purpose— to study the relations between the posterior capsule (PC) and intraocular lens (IOL) after cataract surgery in pseudoexfoliation syndrome (PEX).Patients and methods. We examined 46 eyes of 37 patients with PEX who underwent a standard and uncomplicated phacoemulsification. The age of patients was 60–94 years. Postoperative period ranged from 1 day to 10 years. An optical coherence tomography (OCT) (RTVue XR Avanti, “Optovue”) was used to image the IOL-PC space in early and late postoperative period.Results. In the first days full contact PC-IOL was not observed in any case. The maximum of space PC-IOL was noted on the first day postoperatively. Posterior capsule had a wavy or folded profile on the scans. In the next two weeks we observed a decrease of the distances between posterior capsule and IOL. After 1 month we noted the formation of capsular bend around optic edge, the full adhesion of posterior capsule to IOL was not detected. In the late postoperative period the fibroplastic and proliferative capsular changes with secondary discontact PC-IOL was noted. Primary inadhesion of a posterior capsule to IOL was recorded in half of the cases.и. High resolution OCT was suitable for quantitative analysis of IOL-PC space. Involution changes in structures of anterior segment in the eyes with PEX had a role in closure of the IOL-PC space. Complete adhesion of posterior capsule to IOL was not observed in the majority of eyes with PEX.

Visual Outcome of Phacoemulsification versus Small Incision Cataract Surgery in Pseudoexfoliation Syndrome - A Pilot Study.

Available data has highlighted the efficacy of both Phacoemulsification (PHACO) and Small Incision Cataract Surgery (SICS) in the presence of Pseudoexfoliation (PEX) syndrome. In developing countries, both are commonly performed procedures for cataract extraction. But, no direct comparison between these two procedures is available in the setting of PEX syndrome. With this lacuna in mind, this pilot study decided to compare the visual outcomes of both these techniques in the setting of PEX syndrome. To compare and analyze the efficacy and safety of PHACO versus SICS in patients of PEX syndrome who underwent cataract surgery. A prospective, conveniently sampled, observational, pilot study was conducted over six months in ophthalmology department of a tertiary eye institute in India. A total of 200 eyes of 100 patients conforming to pre-defined criteria were conveniently sampled and allotted to two groups of 50 patients each. First group underwent PHACO and second underwent SICS. The demographic profile, pre-operative, intra-operative and post-operative details and complications as well as visual acuity were recorded. Data obtained was analyzed using chi-square test. Statistical significance was set at 95% Confidence Intervals (CI), i.e., at a p-value of <0.05. Of 76 males and 24 females, the mean age was 67.95 years. No statistically significant differences were observed between PHACO and SICS groups with regards to intra-operative complications {overall n=13 in PHACO versus n=21 in SICS, p=0.13}. Controlled sphincterotomy was required in a significantly higher number of SICS cases (p=0.03). No statistically significant differences were observed in terms of post-operative complications (overall n=5 in PHACO versus n=10 in SICS, p=0.26). With careful pre-operative assessment, due to intra-operative modifications and surgical expertise, both PHACO and SICS are apparently safe procedures in PEX syndrome.

Anterior Chamber Depth Change Following Cataract Surgery in Pseudoexfoliation Syndrome; a Preliminary Study.

Purpose:To assess the pseudophakic anterior chamber depth (PP-ACD) or effective lens position (ELP) change after cataract surgery in patients with pseudoexfoliation syndrome (PEX).Methods:Consecutive eyes with PEX and cataract underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). Eyes with severe PEX and with axial length (AL) greater than 24 mm or less than 22 mm were not included. Eyes with capsular complication or unstable bags that needed capsular tension ring insertion were excluded. The SRK-II formula was applied to calculate IOL power for postoperative emmetropia. PP-ACD or ELP was measured using anterior segment optical coherence tomography. Data obtained at one and six months post operation were evaluated during analysis.Results:Twenty-six eyes of 26 subjects (mean age: 72 years; range: 60–84 years) were studied. PP-ACD was deepened (mean change: 0.08 mm) and a concurrent hyperopic shift (0.3 D) was observed postoperatively between month 1 and month 6 (P values ≤0.002). PP-ACD and postoperative refraction changes were correlated with age and AL (P values < 0.025), respectively. Increased hyperopic shift and PP-ACD deepening in eyes with posterior capsule opacification (PCO) was noted postoperatively at six months, but the difference was not statistically significant (P values = 0.15 and 0.2, respectively).Conclusion:After cataract surgery in eyes with PEX syndrome, a significant backward movement of the IOL occurs postoperatively in the first six months, which is associated with a concurrent small hyperopic shift.

Cataract surgery in pseudoexfoliation syndrome

To discuss the preoperative, intraoperative and postoperative considerations and techniques for cataract surgery in pseudoexfoliation syndrome. Pseudoexfoliation syndrome is a common disorder worldwide that has been linked to the lysyl oxidase-like-one (LOXL1) gene. Its identification in patients undergoing cataract surgery has become important in preventing complications through proper preoperative planning. The management of the small pupil found in pseudoexfoliation can be achieved using various pharmacological and mechanical techniques. There are now several devices available to support the weak zonules that commonly accompany pseudoexfoliation. Postoperatively, pseudoexfoliation patients need to be followed closely to monitor for complications such as intraocular pressure spikes, inflammation and intraocular lens dislocation. With proper preoperative preparation, intraoperative use of appropriate adjunctive devices, and close postoperative follow-up, favorable outcomes can be achieved in cataract surgery in pseudoexfoliation syndrome.

Spontaneous Complete Dislocation of the Lens in Pseudoexfoliation Syndrome

Spontaneous dislocation of the lens results from intraocular disease giving rise to mechanical stretching, inflammatory destruction or degeneration of the zonule. Degeneration of the zonule occurs particularly with hypermature cataract, high myopia or retinal detachment, but it is also a well-recognized condition associated with pseudoexfoliation syndrome (PES). Lens dislocation during cataract surgery in PES and spontaneous subluxation of the lens associated with PES have been previously reported. We describe a case of spontaneous complete dislocation of the lens in PES.

Complications of Extracapsular Cataract Extraction in Patients with Pseudoexfoliation Syndrome

Objective: To evaluate the complications of extracapsular cataract extraction in patients with pseudoexfoliation (PE) syndrome. Study Design: A retrospective study of patients operated on between 1990 and 1992. Setting: Hacettepe University School of Medicine, Department of Ophthalmology. Patients: Seventy-three patients with PE syndrome. The mean age of the patients was 71.3 ± 8.0 years with ages ranging between 54 and 89. There were 42 male patients with a mean age of 71.8 and 31 female patients with a mean age of 70.6. Results: Pupillary irregularity was the most frequent complication (23.3%) in the study. The other complications were as follows: posterior capsule rupture in 6.8%, posterior capsule rupture with vitreous loss 4.1%, fibrinoid reaction in 4.1%, posterior synechia in 4.1%, intraocular lens (IOL) decentralization in 2.7% and UGH syndrome in 1.4%. Conclusions: Cataract surgery in PE syndrome may be linked to several problems. Eyes with PE may show spontaneous subluxation of the lens. The zonular fibres are known to be weak in PE syndrome and the central posterior lens capsule very thin. However the low rates of complications of ECCE with and without IOL implantation has convinced us that this procedure is relatively safe in patients with PE syndrome.