Phacoemulsification in Pseudoexfoliation Syndrome Akram Rismanchian MD Farabi
Phacoemulsification in Pseudoexfoliation Syndrome Akram Rismanchian MD Farabi Hospital Isfahan University of Medical Sciences
Phaco in pseudoexfoliation syndrome In exfoliation syndrome a basement membrane like fibrillogranular white
material is deposited on the lens, cornea , iris , anterior hyaloid face, ciliary processes, zonular fibers , and trabecular meshwork It is known that eyes with PEX are
at higher risk for developing openand closed- angle glaucoma and cataract Patients with exfoliation syndrome may also experience weakness of the zonular
fibers and spontanous lens subluxation and phacodonesis Cataract formation is more pronounced and development at an earlier age in eyes with
pseudoexfoliation syndrome (PXF) Cataract surgery then can be challenging because of a small pupil and a loose zonules an increased risk for complication during surgery.
In many studies cataract surgery in the presence of PEX has been reported to be associated with increased risk of intraoperative and postoperative
complications such as zonular dialysis, vitreous loss, prolonged corneal edema, sustained inflammatory reaction and lens decentration
Zonular instability, poorly dilating pupils, corneal endothelial changes and breakdown of the blood-aqueous barrier are the leading factors in increased intraoperative and postoperative complications in eyes with
PEX PXF is associated with -
Higher incidence of glaucoma Loss of zonular integrity Lens subluxation and phacodonesis Poorly dilating pupil (hyporeactive) Fibrotic capsule
Small pupils It is relative contraindication for the inexperienced phaco-surgeon. Preop evaluations of pupil:
- Dynamic ,direct light. - Static ,mydriatic. Small pupil 4 mm, may be classified as: -hyporeactive pupil, hyperopia, DM,PXF.age
- Fixed pupil ,pilo, PS, neurologic. Small pupils cont
Techniques For intraoperative manipulation of pupil size -Intracameral adrenalin 0.1 cc of 1/10,000 -Viscomydriasis with hyperviscosity,
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