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    • 13 FEB 18
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    Cataracts and Pseudoexfoliation

    Pseudoexfoliation is an ocular condition in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations. The shedding of the material can make structures within the eye less resilient. Studies suggest pseudoexfoliation to be 0.6 percent in 52- to 64-year-olds rising to 5 percent in 75- to 85-year-olds.

    Pseudoexfoliation is routinely identified during a dilated examination of the eye. A white, flaky substance is seen on the boarder of the iris (pupil) and on the front surface of the lens (cataract). A “three-ring sign” on the lens is usually telltale. These three rings (zones) are associated with the rubbing of the iris pseudoexfoliative material on to the lens (cataract).

    Pseudoexfoliation of the lens (cataract)

    Pseudoexfoliation of the lens (cataract)

     

    When present pseudoexfoliation could result in weakness of the lens (cataract) supportive zonules.

    Zonules

    Zonules

    After the iris sheds pseudoexfoliative material, the pupil could become resistant to dilation drops. This could lead to partial pupil dilation during eye examinations and eye surgery. If the pupil dilation is suboptimal pupil eye surgery expansion devices may be indicated.

    Some intraocular lenses (IOL) used in contemporary cataract surgery depend on positioning within the eye for optimum effectiveness. Selection of an IOL for cataract surgery should be carefully considered. Frail pseudoexfoliation cataract zonules could affect the final position of the IOL. If the zonule frailty progresses (sometimes years after IOL implantation surgery) IOL position could change. This change in position could create focusing difficulties.

    A topic of contemporary debate among eye surgeons is if Laser Assisted Cataract Surgery be the preferred surgical method of addressing pseudoexfoliation cataracts. Laser Assisted Cataract Surgery traditionally minimizes the stress to the zonules which could be an advantage over Phacoemulsifcation cataract surgery without use of a laser.

     

     

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