Pseudo-exfoliation (PXF) syndrome can make cataract surgery more challenging because of the concomitant issues that exist in these eyes. The pupil dilation is compromised, the zonular structures are weakened, the risk of glaucoma is higher, and the capsular support can be compromised. Can we use maximum pupil size to determine the degree of PXF and the anticipated intra-operative challenges during cataract surgery?
When we assess these patients at the pre-operative visit, can we determine the relative risk of intra-operative complications ahead of time? As the PXF material gets deposited and distributed within the eye, we begin to see more issues. The deposits on the anterior lens capsule may reflect the level of zonular structure compromise. A shallow anterior chamber, particularly in the setting of a normal or long axial length, may indicate weakness and mobility of the entire lens-iris diaphragm. A small pupil, particularly one with PXF deposits at the margin, may indicate a greater degree of tissue compromise which would increase the risks of surgery and potential complications.
In the video presented here, we compare two different eyes (from two different patients): one with an 8 mm dilation and the other with just a 4 mm dilation. Both eyes received the same maximum amount of pharmacologic agents for dilation.
Remember that since PXF syndrome is a chronic, long-standing disease process, there can be late-stage complications such as dislocation of the entire capsular bag-IOL complex many years after cataract surgery.
Click below for the video of pupil size in pseudo-exfoliation syndrome:
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