Surgical Chalenges In Advanced Cataracts With Pseudoexfoliation Syndrom

Pseudoexfoliation is the most common cause of secondary glaucoma, and patients with this syndrome compared to others have a higher rate of intraoperative and postoperative complications during cataract surgery, especially in advanced (hard or white) cataracts.

The aim of the study was to evaluate the frequency and type of intraoperative and postoperative surgical complications of advanced cataracts in patients with pseudoexfoliative syndrome.

Specialized Eye Hospital "Denica", Skopje, North Macedonia

Retrospective study of patients with pseudoexfoliative syndrome and cataract surgery performed during one year (2021), with a follow-up of 3 months. All eyes underwent a complete ophthalmological examination. Preoperative parametars were: visual acuity, tonometry, biomicroscopy, grading of cataract.  Postoperative parameters: visual acuity, tonometry, biomicroscopy, IOL positioning, postoperative fundus examination and optical coherence tomography (OCT) of the optic nerve.

55 eyes were evaluated, of which 32 (58.2%) had grade 4 (hard, brunescent) cataracts, and the remaining 23 eyes had hypermature (white) cataracts. The average age was 72.8 years. 25 eyes (45.5%) had previously diagnosed glaucoma for which they were receiving therapy.

The mean preoperative visual acuity (Snellen decimal chart) was 0.089±0.03, with 39 eyes (70.9%) having a visual acuity of less than 0.1. Intraoperatively, the most frequent complication was insufficient pupillary dilatation, for which Malyugin's pupillary dilator was used in 32 eyes (58.2%). Zonular dehiscence was observed in 8 eyes (14.5%), and due to great instability of the capsule, an anterior chamber lens was implanted in 3 of them. Posterior capsule rupture occured in 3 eyes (5.5%) requiring anterior vitrectomy and intraocular lens placement over the anterior capsular rim. Postoperatively the mean visual acuity was 0.73±0.06.

Pseudoexfoliation advanced cataract surgery carries a significant risk of intra- and postoperative complications. The planned surgical approach using modern techniques of phacoemulsification, viscoelastics, pupillary dilators significantly improves the postoperative outcome. In order to reduce the risk of complications in patients with pseudoexfoliation, cataract surgery should be advised in the early stages.