1620: pseudo-exfoliation cataract surgery

When it comes to patients with pseudo-exfoliation (PXF) and cataracts, does the pre-operative examination predict the intra-operative challenges? The title picture shows the pre-operative exam and the degree of pupil dilation after two sets of phenylephrine 2.5% and tropicamide 1% whereas the intra-op pic shows more dilation since the patient received phenylephrine 10%, tropicamide 1%, and cyclopentolate 1% for three sets on the morning of surgery. Does degree of dilation predict more issues with PXF? I think there is a good correlation there patients with very poor dilation due to PXF often have worse zonular support. Another great pearl is to compare the anterior chamber depth seated at the slit-lamp versus supine on the operating room table. If there is laxity and movement of the lens iris diaphragm (with a shallow AC seated at the slit-lamp and then a deep AC when supine), then you know that there will be challenges! This is a complete cataract case with me as the operating surgeon.

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