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Category: Volume 08 Issue 03 March 2020
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Title: Outcome of Small Incision Cataract Surgery in patients with pseudoexfoliation syndrome

Authors: Dr S. Vishali, Dr Loganathan, Dr Annapurna Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.94

Abstract

   

Introduction

Lindberg first described pseudoexfoliation (PXF) in 1917.(1)(2) Pseudoexfoliation syndrome is an age related, genetically determined, multifactorial disease of the elastic structures. It is usually a bilateral disorder but markedly asymmetric. This disease remains subclinical. It is commonly deposited on the corneal endothelium, iris, anteriorlens capsule, zonules of the lens and trabecular meshwork.(3)(4)

Apart from ocular tissues, it is also seen in other parts of the body such as lungs, heart, kidney, liver, blood vessels and cerebral meninges. Presence of pseudoexfoliation material in extra ocular tissues suggest PXF is a multi-organ disorder. Hence patients having ocular PXF may present with systemic manifestations like hypertension, angina, cardiovascular disease, abdominal aortic aneurysm, transient ischemic attacks and stroke. (4)(5)(6)

It is important to diagnose PXF before cataract surgery since it predisposes to complications mainly due to poor mydriasis and weak zonules. The complications that can occur before and during cataract surgery are poor mydriasis, subluxation or dislocation of lens, glaucoma, zonular dialysis, posterior capsule rupture, vitreous loss.(1)(7) Postoperatively decentration or dislocation of the Intra ocular lens (IOL) can occur due to progressive proteolytic disintegration of the suspensory ligament causing weakening of the capsular support and zonular apparatus.(8)(9)

Further pupillary dilatation is poor or inadequate due to iris atrophy. Post operatively fibrinous reaction and inflammation in the anterior chamber are more common in pseudoexfoliation patients compared to patients without pseudoexfoliation, this is due to a weak blood aqueous barrier in patients with pseudoexfoliation.(10) Corneal endothelial loss also occurs among these patients which can lead on to corneal decompensation.(11)(12)

References

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Corresponding Author

Dr Loganathan

Professor and HOD, Department of ophthalmology, Sri Venkateshwaraa Medical College Hospital and Research centre, Pondicherry