Cataract Surgery in Patients with Pseudoexfoliation

Abstract

Purpose: To study the complications encountered during and after cataract surgery in eyes with pseudoexfoliation and their visual outcome.

Materials and Methods: This non-interventional descriptive study was conducted in the Ophthalmology Department of Lady Reading Hospital, Khyber Institute of Ophthalmic Medical Sciences, Peshawar from June 2002 to December 2002. All patients admitted for cataract surgery during June to September 2002 were examined on slit lamp without and with pupillary dilatation to diagnose pseudoexfoliation. Patients of cataract with pseudoexfoliation above fifty years of age belonging to either sex were included in the study. All patients underwent cataract surgery with intraocular lens implantation. The patients were reviewed up to 60th postoperative day; operative and post-operative complications and the bestcorrected visual acuity on 60th post-operative day were measured.

Results: Thirty-two eyes of thirty patients with pseudoexfoliation underwent cataract surgery, of which twenty (67%) were male whereas ten (33%) were female. Complications encountered during surgery were zonular dialysis five (15.6%) cases, posterior capsular rupture five (15.6%), vitreous loss three (9.4%), residual lens matter in five (15.6%) and hyphema in one (3.1%) case. Post-operative complications were severe anterior chamber reaction in 18 (56.2%) cases, corneal oedema 14 (43.8%), raised intraocular pressure five (15.6%), hyphema three (9.4%), pigment dispersion 13 (40.6%), posterior capsular opacification six (18.8%) cases, while iris prolapse, endophthalmitis, intraocular lens decentration and endothelial decompensation in one (3.1%) case each. Final bestcorrected visual acuity was between 6/6-6/12 in 18 (56.3%) cases, 6/18- 6/36 in ten (31.3%) cases; 6/60 to counting finger in three (9.4%) and one (3.1%) case had visual acuity of hand movement.

Conclusions: Cataract surgery in eyes with pseudoexfoliation has higher incidence of operative complications like posterior capsular rupture, zonular dialysis, vitreous loss and intraocular bleeding. Post-operatively, these patients are at greater risk for developing an immediate elevation of intraocular pressure and inflammation. Posterior capsular opacification and intraocular lens decentration are more common in patients with pseudoexfoliation in post-operative period.