Cover Focus | Mar/Apr '17

Cataract Surgery With Pseudoexfoliation Syndrome

Pseudoexfoliation syndrome is a condition all cataract surgeons must be familiar with. Despite the challenges this presents, by using appropriate surgical techniques, surgeons can obtain excellent postoperative results and perhaps prevent future complications, including capsular bag/IOL dislocation.

A 68-year-old woman presented with pseudoexfoliation syndrome and visually significant cataracts. Visual acuity was 20/50 in each eye. Intraocular pressure was 14 mm Hg in each eye with no medication. Cataract surgery was planned.

As we placed the lidocaine for her right eye surgery, dense pseudoexfoliation material in the subincisional space could be identified. We used the dual-layered viscoelastic system to maintain space in the anterior chamber, taking care not to over-pressurize the eye, as this could place unneeded stress on the zonules.


It is important for surgeons to obtain an adequately sized pupil in an effort to generate a sufficiently sized capsulorhexis

In these cases, obtaining adequate pupil dilation is crucial. A large pupil allows the surgeon to generate a sufficiently sized capsulorhexis. A smaller capsulorhexis can secondarily lead to phimotic syndrome and place additional stress on the zonules.

Using the Pearson hydrodissection cannula, I focused on achieving adequate hydrodissection and then moved on to use of the Chang cannula with the goal of obtaining a freely rotating nucleus. I cleaned up any epinuclear material anteriorly and moved into a standard phaco chop using the Centurion phaco system (Alcon).

During cortex removal, I always pay close attention to the anterior capsular edge, as movement of it can signify zonular weakness in a particular location. Additionally, looking for striae posteriorly can be helpful in identifying zonular compromise. I used the Terry squeegee to complete capsular polishing.

I could see glimpses of lens material posterior to the posterior capsule. The presence of this material suggests some loss of integrity in the zonules. For this reason, I used a capsular tension ring. At the conclusion of the case, I observed minimal overlap of the optic edge with the anterior capsule and a nicely positioned lens.

It is important for surgeons to obtain an adequately sized pupil in effort to generate a sufficiently sized capsulorhexis. These two steps can help ensure long-term stability of the IOL in patients with pseudoexfoliation syndrome.

Matthew Rauen, MD
  • Cataract, cornea, and refractive surgeon, Wolfe Eye Clinic, Des Moines, Iowa
  • Financial disclosure: None acknowledged