Pseudoexfoliation syndrom and cataract: results and complication frequency in immature and mature cataract surgery Marijana Bilen Babić Department of.

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Presentation transcript:

Pseudoexfoliation syndrom and cataract: results and complication frequency in immature and mature cataract surgery Marijana Bilen Babić Department of Ophthalmology, Clinical Hospital Center Rijeka, Croatia Maja Merlak Department of Ophthalmology, Clinical Hospital Center Rijeka, Croatia No Financial Interest

Pseudoexfoliation syndrome (PEX) Purpose the aim of our study was to evaluate intraoperative and postoperative mature and immature cataract surgery results and complications in eyes with pseudoexfoliation (PEX syndrome), compared with mature and immature cataract surgery results in the eyes without PEX syndrome Pseudoexfoliation syndrome (PEX) complex, multifactorial age-related systemic disease manifesting itself primarily in the anterior segment of the eye: corneal endothelial dysfunction iris-dysfunction of the blood-chamber angle-barrier and anterior segment hypoxia: posterior synechia, pupillary atrophy acceleration of cataract formation and capsular fragility zonular weakness/lens subluxation secondary open-angle glaucoma (pseudoexfoliation glaucoma)-more resistant /poorer prognosis deposition of a microscopic fibrogranular amyloid-like protein material in the anterior segment of the eye cataract surgery in PEX → associated with complicating factors: poor mydriasis, zonular weakness, corneal endothelial dysfunction, capsular phimosis and luxation of the lens

Setting/Venue in our retrospective single-center study, we analyzed the clinical data of 23 eyes with mature cataract and PEX syndrome and 25 eyes with immature cataract and PEX in patients who underwent cataract surgery the results obtained were compared with 48 eyes without PEX syndrom that underwent cataract surgery (control group)

Methods 48 eyes of 46 patiens with PEX syndrome that underwent phacoemulsification cataract surgery were included in the study and results were compared depending on the degree of cataract maturity we analyzed: mean preoperative and postoperative best corrected visual acuity (BCVA) intraocular pressure (IOP) before and 1 month after cataract surgery the rate of surgical intraoperative and postoperative complications all results were compared to the control group without PEX syndrome

Results preoperative BCVA in patients with PEX and mature cataract was 0,024-0,2 and postoperative BCVA was 0,19-0,4 according to Snellen chart preoperative BCVA in patients with PEX and immature cataract was 0,05 -0,3 and postoperative BCVA was 0,024-0,8 according to Snellen chart in the control group, preoperative BCVA was 0,05-0,46 and postoperative BCVA was 0,3-0,87 according to Snellen chart preoperative IOP was in 18,21-18,91 mmHg in PEX group and 17,80-18,19 mmHg in control group postoperative IOP at 1 month follow-up was 17,84-18,2 mmHg in the PEX group and 15,23-17,38 mmHg in the control group 15 cases of PEX eyes and mature cataract (31%) had one or more intraoperative complications (posterior capsule rupture 10,41%, retained lens material 6,25%, phacodonesis/ iridodonesis 4,16%, decentration of IOL 4,16%, hyphaema 4,16%, zonular dialysis 6,25%), compared to 3 eyes (6%) with immature cataract and PEX (retained lens material 2,08%, phacodonesis/ iridodonesis 2,08%, hyphaema 2,08%, zonular dialysis 2,08%) in control group 7 eyes (15%) with mature cataract had intraoperative complications (posterior capsule rupture 6,25%, iridodonesis 2,08% , hyphaema 2,08%) and just 1 eye in immature cataract group

Conclusion cataract surgery with PEX syndrome is associated with a greater number of possible operative complications related to the pathological changes of the intraocular structures, especially depending on the degree of maturity of the cataract in immature cataract there is no difference in the number of complications in patients with PEX compared to those without PEX in mature cataract, there are significant perioperative complications in patients with PEX syndrome phacoemulsification represents a safe method in eyes with PEX with careful surgical technique: maximal mydriasis or use of iris retractor hooks/stretch pupilloplasty for poor pupillary dilatation implantation of endocapsular rings in zonular instability/phacodonesis good intraoperative and postoperative IOP control (hypotensive drug therapy and the evacuation of viscoelastic property)