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Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Rajendran S, Rajalakshmi AR, Srikanth K, Ezhumalai G. Manual small incision cataract surgery: a viable option for cataract with pseudoexfoliation. Int Ophthalmol 2021; 42:1447-1455. [PMID: 34839453 DOI: 10.1007/s10792-021-02134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to assess the spectrum of clinical presentation, intraoperative challenges and immediate surgical outcome of cataract patients with pseudoexfoliation syndrome (PXF) following manual small incision cataract surgery (MSICS). METHODS This prospective observational study which was conducted in a rural tertiary care hospital included adult patients with cataract and associated PXF. MSICS was performed for all after a complete ophthalmic and systemic examination. Clinical profile, intraoperative and post-operative complications were noted. Uncorrected visual acuity on first day post-surgery was used to assess the surgical outcome following MSICS. RESULTS MSICS was performed in 80 eyes with varying grades of cataract and PXF. The mean age of the patients was 62.5 ± 8.9 years. PXF material on pupillary margin in 77(96%) patients was the most common finding noted. Majority of the patients had advanced cataract (72, 90%) and inadequate mydriasis (62, 77.5%). Posterior capsular rent (8, 10%) and zonular dehiscence (8, 10%) were the intraoperative difficulties faced. Uncorrected visual outcome on first post-operative day was moderate to good in 71 (88.8%) patients, limited by post-operative corneal oedema (21, 26.3%), iritis (31, 38.8%) and aphakia (9, 11.3%). CONCLUSION Patients with pseudoexfoliation had poor pupillary dilatation, advanced cataracts and higher rate of posterior capsular rent. Our study showed good outcome of MSICS in PXF patients, even with advanced cataract suggesting that MSICS is a safe, effective and viable option for patients with PXF and cataract.
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Affiliation(s)
- Sruthi Rajendran
- Anand Eye Hospital Clear Vision Centre, Trivandrum, Kerala, India.,Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India.
| | - K Srikanth
- Department of Ophthalmology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
| | - G Ezhumalai
- Senior Statistician & Research consultant, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Pondicherry, 607402, India
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Oustoglou E, Tzamalis A, Mamais I, Dermenoudi M, Tsaousis KT, Ziakas N, Tsinopoulos I. Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System? Cureus 2020; 12:e10693. [PMID: 33133858 PMCID: PMC7593208 DOI: 10.7759/cureus.10693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece, Athens, GRC.,Department of Health and Life Sciences/Epidemiology, Biostatistics and Methodology Research, European University of Cyprus, Nicosia, CYP
| | - Maria Dermenoudi
- Department of Ophthalmology, Health Center of Neapolis, Thessaloniki, GRC
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaliniki, GRC
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
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Benage M, Korchak M, Boyce M, Mayko ZM, Bauer A, Straiko MD, Terry MA, Sáles CS, Greiner MA. Intraoperative fibrin formation during Descemet membrane endothelial keratoplasty. Am J Ophthalmol Case Rep 2020; 18:100686. [PMID: 32292835 PMCID: PMC7149398 DOI: 10.1016/j.ajoc.2020.100686] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 02/22/2020] [Accepted: 03/27/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To describe Descemet membrane endothelial keratoplasty (DMEK) cases complicated by spontaneous intraoperative fibrin formation. Methods DMEK surgeries performed at two centers using a standardized technique were reviewed retrospectively for the occurrence of intraoperative fibrin formation. Cases were assessed for recipient medical history, donor age, best spectacle-corrected visual acuity (BSCVA), intraoperative unscrolling time, 6-month endothelial cell loss (ECL), and the course of the mate donor cornea. Results In this review of 868 cases of standardized DMEK surgery with surgical peripheral iridotomy, 32 eyes of 29 patients (3.7%) were complicated by the formation of intraoperative fibrin formation, including 3 patients that developed fibrin in both eyes. Three of the 32 grafts failed (9.4%). None of the mate corneas transplanted (n = 27) developed complications related to fibrin. The donor age ranged from 51 to 75 years and recipient age ranged from 49 to 82 years (median, 66 years). Unscrolling time ranged from 1 to 105 min (median, 15 min). Nine eyes required one rebubble procedure. No eyes had vision-limiting comorbidities, and the 6-month BSCVA was ≥20/40 in all eyes. Six-month ECL ranged from 19% to 73% (median, 44%). Conclusions We conclude that fibrin formation during DMEK surgery is an uncommon but important complication that can make graft manipulation more difficult, and may have deleterious effects on endothelial cell density and graft survival.
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Affiliation(s)
- Matthew Benage
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michael Korchak
- Department of Ophthalmology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | - Michelle Boyce
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Zachary M Mayko
- Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
| | - Alex Bauer
- Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
| | - Michael D Straiko
- Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
| | - Mark A Terry
- Lions VisionGift, Portland, OR, Devers Eye Institute, Portland, OR, USA
| | | | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Thevi T, Abas AL. Intraoperative and postoperative complications of cataract surgery in eyes with pseudoexfoliation - An 8-year analysis. Oman J Ophthalmol 2019; 12:160-165. [PMID: 31902990 PMCID: PMC6826591 DOI: 10.4103/ojo.ojo_238_2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION: Pseudoexfoliation (PXM) is a fibrillar material deposited in the anterior chamber of the eye and can cause disintegration of zonules and make pupillary dilatation difficult. This can make surgery difficult and result in intraoperative and postoperative complications. The aim of this study was to learn about whether the presence of pseudoexfoliation caused significant complications during cataract surgery. MATERIALS AND METHODS: We did a secondary data analysis of 12,992 eyes from 2007 to 2014 using the National Eye Database of Melaka Hospital Malaysia on intraoperative and postoperative cataract surgery complications of patients with PXM. RESULTS: Patients with PXM were 2.68 times more likely to get intraoperative complications (P < 0.001). They had a higher incidence of lens subluxation, zonular dehiscence, and vitreous loss (P < 0.001). Although posterior capsule rupture (PCR) was the most common intraoperative complication during cataract surgery (4.8%), the presence of pseudoexfoliation was not associated with PCR (P > 0.05). We did not observe any association between patients with pseudoexfoliation and any of the postoperative complications such as corneal decompensation, raised intraocular pressure, and intraocular lens decentration (P > 0.05). Pseudoexfoliation did not cause corneal decompensation (P > 0.05) although corneal decompensation was the highest postoperative complication of cataract surgeries (0.18%). CONCLUSIONS: Patients with PXM had a higher rate of intraoperative complications which were mainly vitreous loss and zonular dehiscence and also lens subluxation/dislocation. We observed poorer visual outcomes in those with PXM following cataract surgery. Patients with pseudoexfoliation should be identified and precautions taken to minimize these complications to get better visual outcomes.
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Affiliation(s)
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka Manipal Medical College, Melaka, Malaysia
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Borkenstein AF, Borkenstein EM. Surgical experience with a redesigned, fully preloaded, hydrophobic acrylic intraocular lens in challenging cases of pseudoexfoliation syndrome, phacodonesis, and small pupils. Clin Ophthalmol 2019; 13:199-206. [PMID: 30774299 PMCID: PMC6348969 DOI: 10.2147/opth.s194420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose The purpose of this study was to describe our surgical experience and evaluate safety and postoperative outcomes of a fully preloaded, monofocal, hydrophobic acrylic intraocular lens (IOL) (CT LUCIA 611P) with a newly designed optic-haptic junction in severe cases of pseudoexfoliation (PXF) syndrome, phacodonesis, and small pupils. Setting This study was conducted in Borkenstein & Borkenstein, private practice, Privatklinik der Kreuzschwestern Graz, Austria. Patients and methods This study presents outcomes of 15 eyes of 15 patients implanted with CT LUCIA 611P IOL with improved optical properties and more rigid and wider optic– haptic junction. All patients had advanced cataract and PXF syndrome, of which phacodonesis was detected in 12 cases and five cases had PXF glaucoma. All eyes had small pupils with no response to mydriatic drops, and the surgery was performed with the use of Malyugin ring. All eyes were targeted for a slight postoperative myopia (−0.25 to −0.50 D). Refractive outcomes were presented for 3 months follow-up, while adverse events were followed up for to 10 months. Results The mean age of the study group was 78.3 years (from 68 to 86 years). Three months postoperatively, the mean manifest spherical equivalent was −0.35 D (from 0.00 to −1.00 D) and all eyes were within ±0.50 D of their preoperative target. No significant refractive shift or refractive surprise occurred during the follow-up of 10 months. Corrected distance visual acuity (CDVA) improved from the mean value of 20/50 preoperatively to 20/20 postoperatively. No intraoperative adverse events were noted. Postoperatively, six eyes presented with a slight decentration or tilt, which did not significantly affect postoperative refraction, CDVA, or patients’ subjective visual symptoms. Conclusion The IOL provided good surgical performance, excellent refractive stability, and predictable outcomes in patients with PXF syndrome. Further studies are necessary to evaluate long-term stability.
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Decorin, Tenascin C, Total Antioxidant, and Total Oxidant Level Changes in Patients with Pseudoexfoliation Syndrome. J Ophthalmol 2018; 2018:7459496. [PMID: 30116633 PMCID: PMC6079450 DOI: 10.1155/2018/7459496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 02/02/2023] Open
Abstract
Purpose Pseudoexfoliation syndrome (PEX) is an eye disease that develops under the influence of regional population differences, genetic factors, age, and environmental factors and is characterized by visualization of a gray-white fibrogranular substance in the lens anterior capsule and/or pupil margin during anterior segment examination. The underlying biochemical mechanisms of the disease have not yet been fully elucidated. Therefore, this study was designed to show the changes in aqueous humor and blood serum levels of matrix metalloproteinases (decorin and tenascin C), total antioxidants (TAS), and total oxidants (TOS) in both cataract patients who have unilateral PEX material and cataract patients who do not have unilateral PEX material. Methods Biological samples were simultaneously collected from 22 cataract patients who had unilateral pseudoexfoliation (PEX patients) and 22 cataract patients who did not have unilateral pseudoexfoliation (control patients). From the collected biological samples, decorin (DEC) and tenascin C (TN-C) were measured with the enzyme-linked immunosorbent assay (ELISA) method, and TAS and TOS were measured with an autoanalyzer. Results When decorin, tenascin C, and TOS values of PEX patients were compared with those of control patients, there was a statistically significant increase in all three parameters. Conversely, TAS values showed a statistically significant decrease in PEX patients compared to controls. DEC, TN-C, TAS values, and TOS values were significantly higher in aqueous fluid than in blood in both the PEX patient and control groups. Conclusions We suggest that parameters such as DEC, TN-C, TAS, and TOS play a role in the etiopathology of pseudoexfoliation syndrome. Thus, bringing these increased levels of extracellular proteins and TOS and decreased levels of TAS back to within physiological limits can mediate the reorganization of the blood-aqueous fluid barrier and slow the progression of pseudoexfoliation syndrome.
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Thevi T, Maizura Z, Abas AL. The Melaka Hospital cataract complications study analysis of 12,992 eyes. Indian J Ophthalmol 2017; 65:24-29. [PMID: 28300736 PMCID: PMC5369289 DOI: 10.4103/ijo.ijo_452_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.
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Affiliation(s)
- Thanigasalam Thevi
- Department of Ophthalmology, Hospital Melaka; Clinical Research Centre, Hospital Melaka, Malaysia
| | - Zin Maizura
- Clinical Research Centre, Hospital Melaka, Malaysia
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka-Manipal Medical College, Melaka, Malaysia
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Trikha S, Agrawal S, Saffari SE, Jayaswal R, Yang YF. Visual outcomes in patients with zonular dialysis following cataract surgery. Eye (Lond) 2016; 30:1331-1335. [PMID: 27285326 DOI: 10.1038/eye.2016.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 04/15/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate the visual outcomes of patients with zonular dialysis following cataract surgery.Patients and methodsMedical records of all patients with documented zonular dialysis, either pre- or peri-operatively, undergoing cataract surgery between 2004-2010 at Queen Alexandra Hospital, Portsmouth, were retrospectively reviewed. Baseline demographics and biometry were analysed, and ocular co-morbidities documented. Intraoperative complications and the use of a capsular tension ring (CTR) were identified. Early and late best-corrected visual acuity (BCVA) post surgery were determined using LogMar values. Univariate and multivariate linear regression analysis was performed to determine associations with BCVA post surgery, and further subgroup analysis performed in groups determined by CTR use.ResultsThe records of 22 312 consecutive eyes undergoing cataract surgery were reviewed. The incidence of zonular dialysis was 0.50% (111 eyes). A CTR was inserted in 46 eyes. Using a multivariate linear regression model, better initial pre-operative BCVA (P=0.019), the use of a CTR (P=0.014), and the absence of vitreous loss during surgery (P=0.008, β 0.45) were associated with improved early postoperative BCVA (mean follow-up 6.6 weeks). Better medium-term postoperative BCVA was significantly associated with preoperative BCVA (P=0.002) and the use of a CTR during surgery (P=0.004, β -0.41).ConclusionsThe overall incidence of zonular dialysis is low. CTR use intra-operatively suggests improved early and medium-term BCVA and should be considered in all cases of zonular dialysis.
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Affiliation(s)
- S Trikha
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - S Agrawal
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
| | - S-E Saffari
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - R Jayaswal
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
| | - Y F Yang
- Department of Ophthalmology, Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, UK
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Hemalatha BC, Shetty SB. Analysis of Intraoperative and Postoperative Complications in Pseudoexfoliation Eyes Undergoing Cataract Surgery. J Clin Diagn Res 2016; 10:NC05-8. [PMID: 27190848 DOI: 10.7860/jcdr/2016/17548.7545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/27/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pseudoexfoliation (PXE) is a genetically inherited condition affecting usually seen in those aged over 50 years. Surgical management of cataract in patients with PXE pose a challenge due to associated changes in ocular structures. AIM To study the challenges in the management of cataract in patients with PXE. MATERIALS AND METHODS This was an interventional study conducted in the Ophthalmology Department of MS Ramaiah Medical College and Memorial Hospital, Bangalore from June 2012 to September 2014. All patients admitted for cataract surgery during this period who were diagnosed as cataract associated with PXE above 50 years of age belonging to either sex were included in the study. All patients underwent cataract surgery with intraocular lens implantation. Depending on type of cataract both small incision and phacoemulsification operations were conducted. Intraoperative and postoperative complications were studied. The patients were reviewed up to 6 weeks postoperatively. RESULTS A total of 50 eyes of 50 patients diagnosed as cataract with PXE underwent cataract surgery. Of which 40 eyes (80%) underwent small incision cataract surgery whereas, 10 (20%) underwent phacoemusification. Corneal thinning (<535 microns) was noted in majority of the cases (41 cases). Preoperatively there were 3 cases of zonular weakness. Pseudo exfoliation with glaucoma was seen in 5 cases. Intraoperative complications encountered during surgery were; zonular dialysis in 3 cases, posterior capsular tear in 2 cases, out of these 5 cases vitreous loss was seen in 3 cases. Postoperative complications were corneal odema in 17 cases, of which endothelium de-compensated in one case, while early posterior capsular opacification was seen in 6 cases. Final best corrected visual acuity was between 6/6-6/12 in 39(78%) eyes, 6/18 -6/36 in 6(12%) cases; 6/60 to less in 5(10%) cases. CONCLUSION Cataract surgery in eyes with PXE has higher incidence of intraoperative and postoperative complications. A complete preoperative workup helps reduce intraoperative complications and maximises the postoperative results. As corneal thinning is more common a pre-operative pachymetry is desirable to prevent underdiagnoses of glaucoma.
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Affiliation(s)
- B C Hemalatha
- Assistant Professor, Department of Ophthalmology, MS Ramaiah Medical College , Bangalore, Karnataka, India
| | - Sathyendranath B Shetty
- Professor, Department of Ophthalmology, MS Ramaiah Medical College , Bangalore, Karnataka, India
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