Cataract And Pseudoexfoliation: Objective Ubm Imaging Of The Anterior Segment In Exfoliation Syndrome And Exfoliative Glaucoma

Prevalence and earlier occurrence of cataract are higher in pseudoexfoliation syndrome (PEX) ,cataract surgery in these cases is complicated. This study was conducted to evaluate anterior segmePrevalence and earlier occurrence of cataract are higher in pseudoexfoliation syndrome (PEX) ,cataract surgery in these cases is complicated. This study was conducted to evaluate anterior segment parameters by ultrasound biomicroscopy (UBM) in eyes with pseudoexfoliation syndrome.nt parameters by ultrasound biomicroscopy (UBM) in eyes with pseudoexfoliation syndrome.

Military Hospital Of Tunis, Tunisia 

Departement of Ophthalmology

A case-control study was conducted from 1 March 2022 to 30 April 2023 in the ophthalmology department of the Military Hospital of Tunis. One hundred and fifty-three eyes of 83 patients were enrolled, categorized into three groups: uncomplicated PEX (51 eyes), exfoliative glaucoma (XFG, 53 eyes), and controls (49 eyes). The level of zonular damage was graded (0 to 4) by UBM, retaining the most severe value among the four meridians. Superior axial scanning was employed for angle assessment. Measured parameters included anterior chamber depth (ACD), pupillary diameter (PD), iris thickness (IT) at 750 µm posterior to the scleral spur, iris-lens contact distance (ILCD), lens vault (LV), and angle parameters (AOD500/750 and TISA500/750).

Zonular involvement was significantly different among the groups, being more severe in XFG than in uncomplicated PEX and in both exfoliation groups versus controls (all p < 0.001). In the PEX group, 2% of eyes were stage 2, 51% stage 3, and 47.1% stage 4; in the XFG group 1.9% were stage 2, 15.1% stage 3 and 83% stage 4. PD in darkness was significantly reduced in XFG versus PEX (p = 0.002) and in PEX versus controls (p < 0.001). Angle parameters did not differ significantly between PEX and XFG, but differed between each exfoliation group and controls. IT was significantly increased in PEX and XFG compared with controls, and both ILCD and LV were higher in PEX and XFG versus controls. ACD was decreased in PEX compared to controls

UBM indicates marked zonular participation in PEX, most of all in exfoliative glaucoma, with a high rate of advanced zonular disintegration. Small pupillary diameter, iris thickness, shallow ACD, and high lens vault together with increased iris–lens contact reflect iris stiffness and anterior lens shift due to weakened zonules. Such anatomical features explain the additional technical burden and risk during cataract surgery in PEX eyes.